• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.3
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• pp.291-301
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• 2024

This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy. The studies were specifically selected for their relevance to the impact of PPS or the transition from fee-for-service (FFS) to PPS. The study analyzed six papers, with three eligible for meta-analysis, to assess the impact of the shift from FFS to PPS in laparoscopic and open cholecystectomy procedures. Our findings indicated no significant changes in LOS and mortality rates following the transition from FFS to PPS. Complication rates varied and were influenced by the diagnosis-related group categorization and surgeon cost profiles under episode-based payment. There was a slight increase in admissions and readmissions, and mixed effects on hospital costs and financial margins, suggesting varied responses to PPS for cholecystectomy procedures. The impact of PPS on cholecystectomy is nuanced and varies across different aspects of healthcare delivery. Our findings indicate a need for adaptable, patient-centered PPS models that balance economic efficiency with high-quality patient care. The study emphasizes the importance of considering specific surgical procedures and patient demographics in healthcare payment reforms.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.1-10
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• 2017

Objectives : The purpose of this study is to investigate the practice patterns of traditional Korean medicine (TKM) doctors and the acceptance of payment model in order to develop a new TKM health insurance payment model linked with TKM clinical practice guidelines (CPGs). Methods : Lumbar herniated intervertebral disc (HIVD) and idiopathic facial palsy (IFP) were selected as a test diseases to develop a new TKM payment model. The level of benefit coverage in the National Health Insurance (NHI) was designed. The survey asked 228 TKM doctors about their practice patterns in HIVD and IFP patients and acceptance of new payment model. Results : Mean of medical cost for treatment of HIVD was 441,000 KW, mean of treatment period ranged from 4.9 to 17.5 weeks, and mean of number of treatment ranged from 14.6 to 50.4 HIVD patients. In the case of IFP, mean of medical cost for treatment of IFP was 468,000 KW, mean of treatment period was at least 4.2 and up to 15.9 weeks and mean of number of treatment ranged from 14.2 to 52 IFP patients. Conclusions : Current study suggests that mixed payment model of per-visit and episode-based model seem to be proper. The model 1 bundles both items which were covered and not covered by NHI in a rational way. The model 2 is based on the development and application of critical pathway. Lastly, model 3 suggests bundling of items covered by current NHI. Acceptance of TKM doctors is expected to be highest in the model 3.

• Health Policy and Management
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• v.23 no.1
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• pp.35-43
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• 2013

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

• Journal of Korean Academy of Nursing
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• v.35 no.5
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• pp.774-786
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• 2005

Purpose: The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. Method: The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a. 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). Result: The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) < 'Low (Cl) < 'Moderate (C2) < 'High (C3), according to dependency in daily activities was in order of Minimum (F0) < 'High (F3) < 'Medium (F2) < 'Low (Fl) < 'Maximum (F4). Resource utilization by HHRGs was the highest 564,735 won in group C0F0S2 (clinical severity minimum, dependency in daily activity minimum, service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. Conclusion: Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.