Paying for the quantity and quality of hospital care: the foundations and evolution of payment policy in England

Health Economics Review

Table 2 Overview of the evolution of the English HRG system

	1st DRG version	2nd DRG version	3rd DRG version	4th DRG version	5th DRG version	6th DRG version
Date of introduction	May 1992	August 1994	June 1997	October 2003	October 2006	Phase 1: April 2013
(Main) Purpose	Patient classification	Patient classification	Patient classification	Patient classification, reimbursement	Patient classification, reimbursement	Patient classification, reimbursement
DRG system	HRG1	HRG2	HRG3.1	HRG3.5	HRG4	HRG4+
Cost and/or performance data used for development	Adaptation of United States DRGs	Data analysis of groupings	Clinical review to refine for ICD-10. Statistical analysis	Clinical Working Groups refined categories.	Expert working groups’	Expert working groups, clinical communities, as well as international casemix developments and best practice*
				Clinical Working Groups refined categories.	micro-costing data
				Statistical analysis	micro-costing data
Number of DRGs	534	533	572	610	Updated annually:	Updated annually:
Number of DRGs	534	533	572	610	1389 (2006/7) to 1657 (2011/12)	2100
Applied to	Public hospitals	Public hospitals	Public hospitals	Public hospitals/private hospitals or treatment centres treating NHS patients	Public hospitals/private hospitals or treatment centres treating NHS patients	Public/private hospitals or treatment centres treating NHS patients
	Acute admissions	Acute admissions	Acute admissions	Acute admissions	Acute admissions	Acute admissions
					Outpatients	Outpatients
					Critical Care	Accident and Emergency
						Critical Care

*Developed in partnership with the clinical community, as represented and endorsed by the Royal Colleges Associations and Professional Bodies. The increased applicability of the Casemix classification to emerging policy requirements has been influenced by findings from the Department of Health's International Review of Classifications, as well as international casemix developments and best practice
Sources: Anthony, 1993 [2]; Benton, 1998 [3]; Casemix Design Authority, 2009 [4]; NHS Information Centre for Health and Social Care, 2008 [5]; Information Standards Board for Health and Social Care, 2009 [6]; National Casemix Office, 2013 [7]; National Casemix Office, 2014 [35]

ISSN: 2191-1991