Browse > Article

Impacts of Implementing Case Payment System to Medical Aid Hemodialysis Patients on Dialysis Frequencies and Expenditure  

Lee, Sun-Hee (Health Insurance Review Agency)
Kim, Han-Joong (Department of Preventive Medicine, College of Medicine, Yonsei University)
Shin, Seung-Ho (Department of Public Health, College of Medicine, Pochon Cha University)
Cho, Woo-Hyun (Department of Preventive Medicine, College of Medicine, Yonsei University)
Kang, Hye-Young (Graduate School of Public Health, Yonsei University)
Publication Information
Journal of Preventive Medicine and Public Health / v.37, no.3, 2004 , pp. 260-266 More about this Journal
Abstract
Objectives : To assess the impacts of implementing case payment system (CPS) to Medical Aid (MA) hemodialysis patients on the frequencies and expenditure of dialysis. Methods : Fifty-eight clinics and 35 tertiary care hospitals were identified as having a minimum of 10 hemodialysis patients for each of the MA and Medical Insurance (MI) programs, who received hemodialysis from the same dialysis facilities for both periods of July 2001 and July 2002. From these facilities, a total of 2,167 MA and 2,928 MI patients were identified as the study subjects. Using electronic claims data, the changes in the total number of monthly treatments and charges for outpatient hemodialysis treatments for each patient after the introduction of the CPS were compared between the MA and MI patients. Multiple regression analyses were performed to examine the independent impact of the CPS on the utilization and expenditure of dialysis treatments among the MA patients. Results : There was a significant decrease in the total charges for the hemodialysis treatments of the MA patients, 3.4% (p<0.05), whereas a significant increase was observed for the MI patients, 2.5% (p<0.05). For both the MA and MI patients, the frequency of the monthly hemodialysis treatments were significantly increased, 5.5 (from 12.1 to 12.7) and 7.8% (from 11.6 to 12.5), for the MA and MI patients, respectively. However, a multivariate regression analysis showed no significant difference in the changes in the total number of monthly hemodialysis treatments between the MA and MI patients after implementation of the CPS. Another regression model, regressing on the changes in the monthly claims of dialysis treatments, showed a significant negative coefficient for the MA ((=-70725, p<0.05). Conclusion : The significant decrease in the total charges for hemodialysis treatments among MA as compared to MI patients suggests that there was a cost reduction in the MA program following the introduction of the CPS.
Keywords
Case payment; Health expenditure; Hemodialysis; Utilization;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Yom YK, Shin JH, Shin YJ, Joa YK, Lee KL Analysis of factors related to the increase in the health care expenditure among Medical Aid population. Korea Health Industry DevelopmmentInstitute. 1998 (Korean)
2 Health Insurance Review Agency. Analysis of Medical Aid patients with high expenditure and development of claims review system 2003 (Kcoean)
3 Health Insurance Review Agency. National report of quality assessment for hemodialysis treatmmts in Korea. 2002.12 (Korean)
4 Campbell DT, Stanley JC. Experimental and quasi-experimental designs for research. Booton; Houghton Mifflin Company: 1963
5 Steinwald B, Dummit LA. Hospital Case-mix change: Sicker Patients or DRG creep. Hlth Affairs 1989; summer: 35-47
6 Simborg DW. DRG Creep:A New Hospital Acquired Disease. N Engl J Med 1981; 304(26): 1602-1604   DOI   PUBMED   ScienceOn
7 Kim CY. Evaluating the effect of DRG payment system. Seoul National University, Department of Health Policy and Management, 2000 (Korean)
8 Scrumers AR, Wholey DR. The effect of HMO competition on gatekeeping, usual source of care, and evaluatirns of physician through-ness. Am J Manag Care 2003; 9(9): 618-627
9 National Medical Insurance Coorpomtion. 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999 Annual Statistics for Medial Aid Program (Korean)
10 Kim H.J., and J.M. Nam. Impacts of the implementation of the DRG based on prospective payment system on the Medicae expenditures. Korean J Prev Med 1994; 27(1): 107-116(Korean)
11 Liaw JJ. Use of a training program to enhance NICU nurses' cognitive abilities for assessing preterm infant behaviors and offering supportive interventions. J Nurs Res 2003; 11(2): 82~92
12 Carter GM,Newhouse JP, Relies DA. How Much Charge in the Case Mix Index is DRG Creep? J Hlth Econ 1990; 9: 411-28
13 Zhang M, Booth BM, Smith GR. Services utilization before and after the prospective payment system by patients with somatization disorder. J Behave Health Serv Res 1998; 25(1): 76-82   DOI