Browse > Article
http://dx.doi.org/10.4332/KJHPA.2013.23.2.103

Simulation on the Change of Practice Pattern after the Introduction of 7 Diagnosis-related Groups Prospective Payment System in a University Hospital  

Shin, Sam-Chul (Department of Health Information and Management, Chungbuk National University College of Medicine)
Kang, Gil-Won (Department of Health Information and Management, Chungbuk National University College of Medicine)
Kim, Sang-Won (Department of Health Information and Management, Chungbuk National University College of Medicine)
Publication Information
Health Policy and Management / v.23, no.2, 2013 , pp. 103-111 More about this Journal
Abstract
Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.
Keywords
Diagnosis-related groups; Clinical practice pattern; Patient simulation;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Kim JH. Re-evaluation of demonstration project by DRG payment system. Korean Health Econ Rev 2002;8(1):59-89.
2 Lee SH, Choi KS, Choi HS, Chae YM, Han EA. A critical review of the application experiences of the DRG reimbursement system in the USA. Korean J Health Policy Admin 2000;10(4):20-56.   과학기술학회마을
3 Health Insurance Review and Assessment Service, Chungbuk National University R&D Foundation, Seoul National University R&D Foundation. Study on the improvement of 7 DRGs prospective payment system. Seoul: Health Insurance Review and Assessment Service; 2009.
4 Davis C, Rhodes DJ. The impact of DRGs on the cost and quality of health care in the United States. Health Policy 1988;9(2):117-131.   DOI   ScienceOn
5 Chulis GS. Assessing Medicare's prospective payment system for hospitals. Med Care Rev 1991;48(2):167-206.   DOI
6 Shin SH. The analysis of change on medical costs and length of stay by DRG demonstration project [dissertation]. Seoul: Yonsei University; 1997.
7 Cho YM. The analysis of medical payment and medical service by DRG payment system [dissertation]. Seoul: Chung-Ang University; 1998.
8 Kang KR. The analysis of change on medical costs and length of stay by the diagnosis-related group payment system: data from a general hospital [dissertation]. Seoul: Korea University; 2010.
9 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.
10 Ministry of Health and Welfare, Seoul National University. Evaluation of the DRG demonstration project and improvement plan 2000.
11 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.   과학기술학회마을   DOI   ScienceOn
12 Ha BM. The impacts of DRG-PPS (diagnosis related groups-prospective payment system) on provider's drug use [dissertation]. Seoul: Seoul National University; 2001.
13 Song SY. Comparative analysis of drug use after the introduction of DRG [dissertation]. Seoul: Chung-Ang University; 2000.
14 Lee MR, Lee YH, Koh 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.   과학기술학회마을
15 Health Insurance Review and Assessment Service, Seoul National University R&D Foundation. Development of the mechanism adjusting DRG payment. Seoul: Health Insurance Review and Assessment Service; 2013.