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Kwak, Sang Hyun,Kim, Ji Hoon,Kim, Da Hee,Kim, Jung Min,Byeon, Hyung Kwon,Kim, Won Shik,Koh, Yoon Woo,Kim, Se-Heon,Choi, Eun Chang Elsevier 2018 Auris, nasus, larynx Vol.45 No.3
<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea.</P> <P><B>Methods</B></P> <P>We retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T).</P> <P><B>Results</B></P> <P>A total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, <I>P </I><0.05). There were no significant differences in length of hospital stay or postoperative complications among groups.</P> <P><B>Conclusion</B></P> <P>The Korean DRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system.</P> <P><B>Level of evidence</B></P> <P>4.</P>
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신포괄수가에 영향을 미치는 의료행태 요인 분석 - 내과 입원환자 중심으로
이경희,위승범,김석일,최병용 한국병원경영학회 2020 병원경영학회지 Vol.25 No.2
Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW –11,900±10,544, whereas it was KRW –196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.
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포괄수가제의 진료행태와 행위별수가제와의 진료비 비교분석
김연,서정아,정영 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.1
Objectives: The purposes of this study were to analyze the quantity of medical services and to identify the factors that create differences in medical costs, medical treatment practices, and the differences in medical costs. Methods: A university hospital which uses the DRG payment system was selected to study. The subjects were the DGRs patients who were discharged from this hospital in the months of January, March, and May of 2000, and January, March, and May of 2001. Data were collected from medical care specification sheets, medical treatment records, and medical service charges. Results: 1. The distribution of subjects in each disease group was 22 DRGs in 8 disease groups among the current 41 DRGs in 8 disease groups. 2. On the medical treatment practices the following 6 factors were identified as significant factors of total costs of DRG: injection costs, operation and delivery costs, bed costs, medication &rescription costs, anesthetic costs and radiation costs. However, there were small differences among medical departments. 3. On the share of medical costs, the number of cases for which patients have to pay the costs decreased in 13 DRGs and the number of cases for which the insurance unions have to pay the costs increased in all 4 departments and in all 14 DRGs. 4. In the 3 departments and 11 DRGs the total DRG costs were higher than the costs for FFS. The difference between the total DRG costs and the total FFS costs were decreased in the year 2001 compared to the difference in the year 2000. Conclusion: As a result, the burden of medical costs for patients and their families has decreased. Therefore, extended application DRG in the practice is necessary. considering the decrease of the difference between the total DRG costs and the total FFS costs and the adequacy of the quantity of medical services. The fairness of the costs should be analyzed for patient groups where the FFS costs appeared to be higher than the total DRG costs. Strategies to eliminate the unnecessary medical services to control medical costs are necessary. Moreover, the proper reimbursement strategies are needed to disseminate the DRG- PPS.
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