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- 주제어 : New Diagnosis Related Groups (New DRG) (검색결과 2 건)
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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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정형선 ( Hyoung Sun Jeong ),조란 ( Lan Cho ) 한국보건경제정책학회 2013 보건경제와 정책연구 Vol.19 No.2
Japan`s Diagnosis Procedure Combination(DPC/PDPS) is a payment system unique to the country, and most characteristically Japanese in view of the DRG payment system throughout the world. While there is a ``bundling part`` having a per diem score diagnosis by diagnosis, the ``non-bundled (free-for-service) items`` are also widely accepted. The ``bundling part`` assigns a high score for a brief stay of hospitalization, thus promoting shortened ALOS. Moreover, ``hospital coefficients`` are prepared to compensate for any monetary loss due to the application of the DPC/PDPS and, on a long term basis, a wide range of incentives are provided to absorb and reflect various additional payments that are already applied under the current fee-for-service system. Though it is a voluntary participating system, many hospitals hope to join the program, meeting participation conditions such as submission of required data. The most outstanding achievement is its building of a database having plenty of clinical information from medical records and payment claims submitted by both DPC-applying and DPC-preparing hospitals to the Ministry. Japan`s DPC system is appraised as stably operative and progressive by succeeding in inducing consensus of interested parties in policy decision-making, and securing a high rate of participation of tertiary hospitals within a short period of time. This conveys a strong message to the Korea`s health insurance system that has failed to inch forward due to the medical providers` opposition in spite of having made efforts to introduce the DRG payment system for a long period of time.
ScienceON
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