Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Differences of Medical Costs by Classifications of Severity in Patients of Liver Diseases

중증도 분류에 따른 진료비 차이: 간질환을 중심으로

  • Shin, Dong Gyo (Research Institute, National Health Insurance Corporation Ilsan Hospital) ;
  • Lee, Chun Kyoon (Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital) ;
  • Lee, Sang Gyu (Graduate School of Public Health, Yonsei University) ;
  • Kang, Jung Gu (Department of General Surgery, National Health Insurance Corporation Ilsan Hospital) ;
  • Sun, Young Kyu (Research Institute, National Health Insurance Corporation Ilsan Hospital) ;
  • Park, Eun-Cheol (Department of Preventive Medicine, Yonsei University College of Medicine)
  • 신동교 (국민건강보험 일산병원 연구소) ;
  • 이천균 (국민건강보험 일산병원 소화기내과) ;
  • 이상규 (연세대학교 보건대학원) ;
  • 강중구 (국민건강보험 일산병원 외과) ;
  • 선영규 (국민건강보험 일산병원 연구소) ;
  • 박은철 (연세대학교 의과대학 예방의학교실)
  • Received : 2012.08.27
  • Accepted : 2013.02.14
  • Published : 2013.03.31
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Abstract

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

Keywords

References

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