DRG 지불제도 도입 후 제왕절개술에서의 의료의 질 변화

Changes in Quality of Care for Cesarean Section after Implementation of Diagnosis-Related Groups/Prospective Payment System

Objectives : To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. Methods : Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were peformed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. Results : Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. Conclusion : This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data emission in medical records.