Browse > Article
http://dx.doi.org/10.4332/KJHPA.2018.28.1.53

Impact of Hospital Specialization on Hospital Charge, Length of Stay and Mortality for Lumbar Spine Disease Inpatients  

Kim, Jae-Hyun (Department of Health Administration, Dankook University College of Medicine)
Park, Eun-Cheol (Institute of Health Services Research, Yonsei University)
Kim, Young Hoon (Department of Healthcare Management, Eulji University Graduate School)
Kim, Tae Hyun (Institute of Health Services Research, Yonsei University)
Lee, Kwang Soo (Department of Health Administration, Yonsei University College of Health Sciences)
Lee, Sang Gyu (Institute of Health Services Research, Yonsei University)
Publication Information
Health Policy and Management / v.28, no.1, 2018 , pp. 53-69 More about this Journal
Abstract
Background: This study investigates association modified category medical specialization (CMS) and hospital charge, length of stay (LOS), and mortality among lumbar spine disease inpatients. Methods: This study used National Health Insurance Service-cohort sample database from 2002 to 2013, using stratified representative sampling released by the National Health Insurance Service. A total of 56,622 samples were analyzed. The primary analysis was based on generalized estimating equation model accounting for correlation among individuals within each hospital. Results: Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a shorter LOS (estimate, -1.700; 95% confidence interval [CI], -1.886 to -1.514; p<0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a lower mortality rate (odds ratio, 0.635; 95% CI, 0.521 to 0.775; p<0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per case (estimate, 192,658 Korean won; 95% CI, 125,701 to 259,614; p<0.0001). However, inpatients admitted with lumbar spine surgery patients at hospitals with higher modified CMS had lower hospital cost per case (estimate, -152,060 Korean won; 95% CI, -287,236 to -16,884; p=0.028). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per diem (estimate, 55,694 Korean won; 95% CI, 46,205 to 65,183; p<0.0001). Conclusion: Our results showed that increase in hospital specialization had a substantial effect on decrease in hospital cost per case, LOS, and mortality, and on increase in hospital cost per diem among lumbar spine disease surgery patients.
Keywords
Hospital; Specialization; Mortality;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Lindlbauer I, Schreyogg J. The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results? Health Care Manag Sci 2014;17(4):365-378. DOI: https://doi.org/10.1007/s10729-014-9275-1.   DOI
2 Kim SJ, Park EC, Jang SI, Lee M, Kim TH. An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: specialty versus small general hospitals. Health Policy 2013;113(1-2):93-99. DOI: https://doi.org/10.1016/j.healthpol.2013.09.013.   DOI
3 Carey K, Burgess JF Jr, Young GJ. Specialty and full-service hospitals: a comparative cost analysis. Health Serv Res 2008;43(5 Pt 2):1869-1887. DOI: https://doi.org/10.1111/j.1475-6773.2008.00881.x.   DOI
4 Theil H. Economics and information theory. Chicago (IL): Rand McNally and Company; 1967.
5 Farley DE. Measuring casemix specialization and the concentration of diagnoses in hospitals using information theory. J Health Econ 1989;8(2):185-207. DOI: https://doi.org/10.1016/0167-6296(89)90003-9.   DOI
6 Farley DE, Hogan C. Case-mix specialization in the market for hospital services. Health Serv Res 1990;25(5):757-783.
7 Lee KS, Chun KH, Lee JS. Reforming the hospital service structure to improve efficiency: urban hospital specialization. Health Policy 2008; 87(1):41-49. DOI: https://doi.org/10.1016/j.healthpol.2007.10.003.   DOI
8 Dobson A, Haught R. The rise of the entrepreneurial physican. Health Aff (Millwood) 2005;24(Suppl W5):494-497.
9 Barro JR, Huckman RS, Kessler DP. The effects of cardiac specialty hospitals on the cost and quality of medical care. J Health Econ 2006;25(4):702-721. DOI: https://doi.org/10.1016/j.jhealeco.2005.11.001.   DOI
10 Daft RL. Organization theory and design. St. Paul (MN): West Publishing Company; 1995.
11 Kim WJ, Lee YC, Kang SH. Specialization of small and medium-size hospitals and managerial performance. Korean J Hosp Manag 1999;4(2):85-105.
12 Homish GG, Edwards EP, Eiden RD, Leonard KE. Analyzing family data: a GEE approach for substance use researchers. Addict Behav 2010;35(6):558-563. DOI: https://doi.org/10.1016/j.addbeh.2010.01.002.   DOI
13 Choudhry S, Choudhry NK, Brennan TA. Specialty versus community hospitals: what role for the law? Health Aff (Millwood) 2005;24(Suppl W5):361-372. DOI: https://doi.org/10.1377/hlthaff.w5.361.
14 Liang KY, Zeger SL. Regression analysis for correlated data. Annu Rev Public Health 1993;14:43-68.   DOI
15 Luft HS, Robinson JC, Garnick DW, Maerki SC, McPhee SJ. The role of specialized clinical services in competition among hospitals. Inquiry 1986;23(1):83-94.   DOI
16 Melnick GA, Zwanziger J, Bradley T. Competition and cost containment in California: 1980-1987. Health Aff (Millwood) 1989;8(2):129-136. DOI: https://doi.org/10.1377/hlthaff.8.2.129.   DOI
17 Kher U, Dawson P, Hylton H. The hospital wars. Time 2006;168(24):64-66, 68.
18 Kim HS, Kim YH, Woo JS, Hyun SJ. An analysis of organizational performance based on hospital specialization level and strategy type. PLoS One 2015;10(7):e0132257. DOI: https://doi.org/10.1371/journal.pone.0132257.   DOI
19 Schneider JE, Ohsfeldt RL, Morrisey MA, Li P, Miller TR, Zelner BA. Effects of specialty hospitals on the financial performance of general hospitals, 1997-2004. Inquiry 2007;44(3):321-334. DOI: https://doi.org/10.5034/inquiryjrnl_44.3.321.   DOI
20 Dayhoff DA, Cromwell J. Measuring differences and similarities in hospital caseloads: a conceptual and empirical analysis. Health Serv Res 1993;28(3):293-312.
21 Herzlinger RE. Let's put consumers in charge of health care. Harv Bus Rev 2002;80(7):44-50, 52-55, 123.
22 Baumgardner JR, Marder WD. Specialization among obstetrician/gynecologists: another dimension of physician supply. Med Care 1991;29(3):272-282. DOI: https://doi.org/10.1097/00005650-199103000-00008.   DOI
23 Herwartz H, Strumann C. On the effect of prospective payment on local hospital competition in Germany. Health Care Manag Sci 2012;15(1):48-62. DOI: https://doi.org/10.1007/s10729-011-9180-9.   DOI
24 Eastaugh SR. Hospital costs and specialization: benefits of limiting the number of product lines. J Health Care Finance 2009;36(2):24-34.
25 Eastaugh SR. Hospital specialization: product-line planning during the market reformation. J Health Care Finance 2011;38(1):71-82.
26 Linna M, Hakkineu U. Determinants of cost efficiency of Finnish hospitals: a comparison of DEA and SFA [Internet]. Espoo: Helsinki University of Technology; 1999 [cited 2018 Jan 20]. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.16.3374&rep=rep1&type=pdf.