보건행정학회지 (Health Policy and Management)

  • 제26권2호
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  • Pages.135-147
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  • 2016
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  • 1225-4266(pISSN)
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  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
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포괄수가제도 당연적용 효과평가

The Effect of Mandatory Diagnosis-Related Groups Payment System

  • 최재우 (연세대학교 대학원 보건학과) ;
  • 장성인 (연세대학교 보건정책 및 관리연구소) ;
  • 장석용 (연세대학교 보건정책 및 관리연구소) ;
  • 김승주 (연세대학교 대학원 보건학과) ;
  • 박혜기 (연세대학교 대학원 보건학과) ;
  • 김태현 (연세대학교 보건정책 및 관리연구소) ;
  • 박은철 (연세대학교 보건정책 및 관리연구소)
  • Choi, Jae-Woo (Department of Public Health, Yonsei University Graduate School) ;
  • Jang, Sung-In (Institute of Health Services Research, Yonsei University) ;
  • Jang, Suk-Yong (Institute of Health Services Research, Yonsei University) ;
  • Kim, Seung-Ju (Department of Public Health, Yonsei University Graduate School) ;
  • Park, Hye-Ki (Department of Public Health, Yonsei University Graduate School) ;
  • Kim, Tae Hyun (Institute of Health Services Research, Yonsei University) ;
  • Park, Eun-Cheol (Institute of Health Services Research, Yonsei University)
  • 투고 : 2016.05.27
  • 심사 : 2016.07.05
  • 발행 : 2016.06.30
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초록

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

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참고문헌

  1. Choi JW, Jeong JW, Kim JH, Kim JL, Park EC. The equity of National Health Insurance contribution in South Korea. Health Soc Welf Rev 2015;25(3):199-221. DOI: http://dx.doi.org/10.15709/hswr.2015.35.3.199.
  2. Choi BH. Management experience for DRG-PPS in the U.S. and evaluation for DRG demonstration project in Korea. Korean Health Econ Rev 1999;5:133-154.
  3. Shin SC, Kang GW, Kim SW. Simulation on the change of practice pattern after the introduction of 7 diagnosis-related groups prospective payment system in a university hospital. Korean J Health Policy Admin 2013;23(2):103-111. DOI: http://dx.doi.org/10.4332/kjhpa.2013.23.2.103.
  4. Kwon S. Payment system reform for health care providers in Korea. Health Policy Plan 2003;18(1):84-92. DOI: http://dx.doi.org/10.1093/heapol/18.1.84.
  5. Park EC, Lee SH, Lee SG. The U.S. experience of the DRG payment system and suggestions to Korea. Korean J Hosp Manag 2002;7(10):105-120.
  6. Health Insurance Review and Assessment, Yonsei University. Effect of mandatory DRG payment system and improvement measurements. Wonju: Health Insurance Review and Assessment; 2015.
  7. Seoul National University. Evaluation and improvement measurements of pilot program on DRG. Seoul: Seoul National University; 2000.
  8. Kang MS, Chung YK, Yeoum SG, Baik KA. Comparative analysis of diagnosis-related-groups payment and fee for service. Chung-Ang J Nurs 2001;5(1):35-41.
  9. Yim J, Kwon YH, Hong DH, Kim CY, Kim YI, Shin YS. Changes in quality of care for cesarean section after implementation of diagnosis-related groups/prospective payment system. Korean J Prev Med 2001;34(4):347-353.
  10. Kim JS, Park HY. A study on patients' satisfaction and service utilization in the DRG based payment system: patients who experienced cesarean section before and after the demonstration program. J Korean Soc Qual Assur Health Care 2000;7(2):190-202.
  11. Kim JH. Revaluation of a pilot program on DRG payment system: focusing on evaluation methodology. Korean Health Econ Rev 2002;8(1):59-89.
  12. Ahn HS, Park HG, Lee HY, Kang MW, Kim YR. Use of antibiotics of hospitals and comparison of antibiotics use before and after the pilot program on DRG payment system. Infect Chemother 2001;19(2):137-143.
  13. Yang SH, Lee JY, Im YS, Han OY, Hong KJ, Ra HO. Mediation use analysis in the application of DRG-based payment system. J Korean Soc Health-Syst Pharm 2000;17(1):135-140.
  14. Lee KJ, Yu SH. Medical services for cesarean section cases in one DRG pilot study hospital. Korean J Hosp Manag 1999;4(2):21-40.
  15. Lee ML, Lee YH, Ko KW. The change of medical care pattern and cost of cataract surgery by the DRG payment system in a general hospital. Korean J Hosp Manag 2005;10(1):48-70.
  16. Health Insurance Review and Assessment, Chung-Buk University, Seoul National University. A study of development plan on seven diagnosis-related groups (DRG). Wonju: Health Insurance Review and Assessment; 2009.
  17. Kim J, Yim E, Bae H. Performance of DRG-based reimbursement policy in National Health Insurance: eight years' experiences. Value Health 2015;18(7):A546. DOI: http://dx.doi.org/10.1016/j.jval.2015.09.1740.
  18. Lee KS, Kang HJ, Nam CM, Cho WH, Kang HY. Variations in hospital length of stay for diagnosis-related groups among health care institutions. Korean J Health Policy Admin 2006;16(2):77-95. DOI: http://dx.doi.org/10.4332/kjhpa.2006.16.2.077.
  19. Choi SJ, Kwon SM, Kang GW, Moon SJ, Lee JS. Variation in hospital length of stay according to the DRG-based prospective payment system in the voluntarily participating providers. Korean J Health Policy Admin 2010;20(2):17-39. DOI: http://dx.doi.org/10.4332/kjhpa.2010.20.2.0167.
  20. Shon C, Chung S, Yi S, Kwon S. Impact of DRG payment on the length of stay and the number of outpatient visits after discharge for caesarean section during 2004-2007. J Prev Med Public Health 2011;44(1):48-55. DOI: http://dx.doi.org/10.3961/jpmph.2011.44.1.48.
  21. Chae HY, Park JY. DRG payment system and health care providers' incentives. Korean Health Econ Rev 2003;9(1):1-24.
  22. Song JK, Kim CY. Participation determinants in the DRG payment system of obstetrics and gynecology clinics in South Korea. J Prev Med Public Health 2010;43(2):117-124. DOI: http://dx.doi.org/10.3961/jpmph. 2010.43.2.117.
  23. Organization for Economic Cooperation and Development. Health at a glance: average length of stay in hospitals. Paris: Organization for Economic Cooperation and Development Publishing; 2015.
  24. Dimick JB, Ghaferi AA. Hospital readmission as a quality measure in surgery. JAMA 2015;313(5):512-513. DOI: http://dx.doi.org/10.1001/jama.2014.14179.
  25. Khan A, Nakamura MM, Zaslavsky AM, Jang J, Berry JG, Feng JY, et al. Same-hospital readmission rates as a measure of pediatric quality of care. JAMA Pediatr 2015;169(10):905-912. DOI: http://dx.doi.org/10.1001/jamapediatrics.2015.1129.
  26. Fischer C, Steyerberg EW, Fonarow GC, Ganiats TG, Lingsma HF. A systematic review and meta-analysis on the association between quality of hospital care and readmission rates in patients with heart failure. Am Heart J 2015;170(5):1005-1017.e2. DOI: http://dx.doi.org/10.1016/j.ahj. 2015.06.026.
  27. Wish JB. The role of 30-day readmission as a measure of quality. Clin J Am Soc Nephrol 2014;9(3):440-442. https://doi.org/10.2215/CJN.00240114
  28. Girotti ME, Shih T, Dimick JB. Health policy update: rethinking hospital readmission as a surgical quality measure. JAMA Surg 2014;149(8):757-758. DOI: http://dx.doi.org/10.1001/jamasurg.2014.163.
  29. Fischer C, Lingsma HF, Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the readmission rate a valid quality indicator?: a review of the evidence. PLoS One 2014;9(11):e112282. DOI: http://dx.doi.org/10.1371/journal.pone.0112282.
  30. Cohn A. Readmission rates are a poor marker of quality. BMJ 2014;348: g1148. DOI: http://dx.doi.org/10.1136/bmj.g1148.
  31. Chen Q, Tsai TC, Mull HJ, Rosen AK, Itani KM. Using a composite readmission measure to assess surgical quality in the Veterans Health Administration: how well does it correlate with established surgical measures? JAMA Surg 2014;149(11):1206-1207. DOI: http://dx.doi.org/10.1001/jamasurg.2014.1095.
  32. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 2013;369(12): 1134-1142. DOI: http://dx.doi.org/10.1056/NEJMsa1303118.
  33. Jian W, Lu M, Chan KY, Poon AN, Han W, Hu M, et al. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission. Health Aff (Millwood) 2015;34(10):1745-1752. DOI: http://dx.doi.org/10.1377/hlthaff.2015.0074.

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  2. Analysis of Changes in Patient Costs in 7Diagnosis-Related Groups through Time Series Analysis vol.11, pp.3, 2017, https://doi.org/10.12811/kshsm.2017.11.3.023
  3. The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals vol.59, pp.4, 2018, https://doi.org/10.3349/ymj.2018.59.4.539