A Taxonomy of Geriatric Hospitals Using National Health Insurance Claim Data

건강보험청구자료로 본 요양병원의 기능 유형

  • Min Kyoung Lim (Health Insurance Research Institute, National Health Insurance Service) ;
  • Sun-Jea Kim (Health Insurance Research Institute, National Health Insurance Service) ;
  • Jeong-Yeon Seon (Health Insurance Research Institute, National Health Insurance Service)
  • 임민경 (국민건강보험공단 건강보험연구원) ;
  • 김선제 (국민건강보험공단 건강보험연구원) ;
  • 선정연 (국민건강보험공단 건강보험연구원)
  • Received : 2023.04.07
  • Accepted : 2023.06.01
  • Published : 2023.06.30

Abstract

Purpose: This study classified the actual functions of geriatric hospitals and examined the differences in their characteristics, in order to provide a basis for discussions on defining the functions of geriatric hospitals and how to pay for care. Methodology: This study used various administrative data such as health insurance data and long-term care insurance data. Cluster analysis was used to categorize geriatric hospitals. To examine the validity of the cluster analysis results, we conducted a discriminant analysis to calculate the accuracy of the classification. To examine cluster characteristics, we examined structure, process, and outcome indicators for each cluster. Findings: The cluster analysis identified five clusters. They were geriatric hospitals with relatively short stays for cancer patients(cluster 1; cancer patient-centered), geriatric hospitals with relatively large numbers of patients using rehabilitation services(cluster 2; rehabilitation patient-centered), geriatric hospitals with a high proportion of relatively severe elderly patients(cluster 3; severe elderly patient-centered), geriatric hospitals with a high proportion of mildly ill elderly patients with various conditions(cluster 4; mildly ill elderly patient-centered), and geriatric hospitals with a significantly higher proportion of dementia patients(cluster 5; dementia patient-centered). The largest number of geriatric hospitals were categorized in clusters 4 and 5, and the structure and process indicators for these clusters were generally lower than for the other clusters. Practical Implications: We have confirmed the existence of geriatric hospitals where the medical function, which is the original purpose of a geriatric hospital, has been weakened. It has been observed that the quality level of these geriatric hospitals is likely to be lower compared to hospitals that prioritize enhanced medical functions. Therefore, it is suggested to consider the conversion of these geriatric hospitals into long-term care facilities, and careful consideration should be given to the review of care-giver payment coverage.

Keywords

References

  1. Yi J, Kim J. The Social cost of informal nursing care and its policy implications for integrated nursing and care services. The Korean Journal of Health Economics and Policy 2021;27(1):97-118.
  2. Ministry of Government Legislation. Long Term Care Insurance Act 2023.
  3. Kim J, Kim S.Park E, J S, Lee E. Policy issues and new direction for comprehensive nursing service in the national health insurance. J Korean Acad Nurs Adm 2017;23(3):312-322. https://doi.org/10.11111/jkana.2017.23.3.312
  4. National Health Insurance Service. 2020 Long term care insurance statistical yearbook 2021.
  5. Ways to reduce the burden of nursing care cost in geriatric hospitals(internal resource). Wonju Si: National Health Care Insurance 2022.
  6. Kim Y, Kim TH, Baek JW, Lee JS, Jeong SY. et al. A study on the development of an implementation strategy for health care supply system. National Health Insurance Service, Seoul National University R&D Foundation 2020.
  7. Kwon SM, Kim HS, Won JI, Lee JY, Kim H. et al. A study on the plan to improve the elderly medical(nursing care) service system through a survey. National Health Insurance Service, Seoul National University R&D Foundation 2013.
  8. Jeon B, Kim H, Kwon S. Patient and Hospital Characteristics of long-stay admissions in long-term care hospitals in Korea. Health Policy Manag 2016;26(1):39-50.
  9. Song HJ, Cha JM. A study on defining functions of geriatric hospitals to efficiently manage elderly care. Wonju Si: Health Insurance Review & Assessment Service 2011.
  10. Park SK, Lee YJ. Categorization of Long Term Care Hospital in Korea Using Cluster Analysis. Journal of Korean Society for Public Health and Medicine 2019;3:71-81.
  11. Kim NS, Yu YS, Park SV, Jeong Y, Kim DE, Choi JH. Development of evaluation model for heatlh policy(1): analysis of the current status and priority setting of evaluation area. Sejong-Si: Korea Institute for Health and Social Affairs 2016.
  12. Health Insurance Review & Assessment Service. 2021(two cycle 3rd) Detailed plans for adequacy assessment in geriatric hospital inpatients. 2022.
  13. Hwang SH, Jang JH. Differences in quality across provider types. Wonju-Si: Health Insurance Review & Assessment Service 2015.
  14. Perrier L, Buja A, Mastrangelo G, Baron PS, Ducimetiere F, Pauwels PJ, et al. Transferability of health cost evaluation across locations in oncology : cluster and principal component analysis as an explorative tool. BMC Health Serv Res 2014;14:537.
  15. Min YJ. Comparison of statistical methods for subgroup classification: cluster analysis, discriminant analysis and latent profile analysis[dissertation]. Seoul: Sejong University;2015.
  16. Lee DH, JEon IH, Kim MH, Kim RY. Basic Study on regular reconciliation to inpatient taxonomy and fee of medical service. Wonju-Si: Health Insurance Review & Assessment Service 2021
  17. Kim Y, Lee SK, Baek JW, Sim HY, Kim YY, Seo WS, et al. Implementation plans for reorganizing the medical supply system by sectors (2021-2023)-first year-. National Health Insurance Service, Seoul National University R&D Foundation 2021.