포괄수가제도 당연적용 효과평가 = The Effect of Mandatory Diagnosis-Related Groups Payment System

다국어 초록 (Multilingual Abstract)

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

참고문헌 (Reference)

1 이미옥, "한 종합병원의 포괄수가제 실시 전후 수정체수술환자의 의료서비스 및 진료비 비교분석" 한국병원경영학회 10 (10): 48-70, 2005

2 최재우, "우리나라 국민건강보험제도의 보험료 부담 형평성에 관한 연구" 한국보건사회연구원 35 (35): 199-221, 2015

3 Tsai TC, "Variation in surgical-readmission rates and quality of hospital care" 369 (369): 1134-1142, 2013

4 Chen Q, "Using a composite readmission measure to assess surgical quality in the Veterans Health Administration: how well does it correlate with established surgical measures?" 149 (149): 1206-1207, 2014

5 Ahn HS, "Use of antibiotics of hospitals and comparison of antibiotics use before and after the pilot program on DRG payment system" 19 (19): 137-143, 2001

6 Wish JB, "The role of 30-day readmission as a measure of quality" 9 (9): 440-442, 2014

7 Khan A, "Same-hospital readmission rates as a measure of pediatric quality of care" 169 (169): 905-912, 2015

8 Kim JH, "Revaluation of a pilot program on DRG payment system: focusing on evaluation methodology" 8 (8): 59-89, 2002

9 Cohn A, "Readmission rates are a poor marker of quality" 348 : g1148-, 2014

10 Kim J, "Performance of DRG-based reimbursement policy in National Health Insurance: eight years’ experiences" 18 (18): A546-, 2015

11 Kwon S, "Payment system reform for health care providers in Korea" 18 (18): 84-92, 2003

12 Jian W, "Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission" 34 (34): 1745-1752, 2015

13 송정국, "Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea" 대한예방의학회 43 (43): 117-124, 2010

14 Lee KJ, "Medical services for cesarean section cases in one DRG pilot study hospital" 4 (4): 21-40, 1999

15 Yang SH, "Mediation use analysis in the application of DRG-based payment system" 17 (17): 135-140, 2000

16 Choi BH, "Management experience for DRG-PPS in the U.S. and evaluation for DRG demonstration project in Korea" 5 : 133-154, 1999

17 Fischer C, "Is the readmission rate a valid quality indicator?: a review of the evidence" 9 (9): e112282-, 2014

18 Dimick JB, "Hospital readmission as a quality measure in surgery" 313 (313): 512-513, 2015

19 Girotti ME, "Health policy update: rethinking hospital readmission as a surgical quality measure" 149 (149): 757-758, 2014

20 Organization for Economic Cooperation and Development, "Health at a glance: average length of stay in hospitals" Organization for Economic Cooperation and Development Publishing 2015

21 Seoul National University, "Evaluation and improvement measurements of pilot program on DRG" Seoul National University 2000

22 Health Insurance Review and Assessment, "Effect of mandatory DRG payment system and improvement measurements" Health Insurance Review and Assessment 2015

23 최숙자, "DRG(Diagnosis-Related Group)를 이용한 포괄진료비 지불제도의 선택 참여에 따른 재원일수 변화" 한국보건행정학회 20 (20): 17-39, 2010

24 박은철, "DRG 지불제도에 대한 미국의 경험과 우리나라에의 시사점" 한국병원경영학회 7 (7): 105-120, 2002

25 손창우, "DRG 지불제도가 재원일수와 퇴원 후 외래방문일수에 미치는 영향: 2004-2007년도 제왕절개술을 중심으로" 대한예방의학회 44 (44): 48-55, 2011

26 이기성, "DRG 지불제도 참여기관의 재원일수 변이에 관한 연구" 한국보건행정학회 16 (16): 77-95, 2006

27 Chae HY, "DRG payment system and health care providers’ incentives" 9 (9): 1-24, 2003

28 Kang MS, "Comparative analysis of diagnosis-related-groups payment and fee for service" 5 (5): 35-41, 2001

29 Yim J, "Changes in quality of care for cesarean section after implementation of diagnosis-related groups/prospective payment system" 34 (34): 347-353, 2001

30 Fischer C, "A systematic review and meta-analysis on the association between quality of hospital care and readmission rates in patients with heart failure" 170 (170): 1005-1017, 2015

31 Kim JS, "A study on patients’ satisfaction and service utilization in the DRG based payment system: patients who experienced cesarean section before and after the demonstration program" 7 (7): 190-202, 2000

32 Health Insurance Review and Assessment, "A study of development plan on seven diagnosis-related groups (DRG)" Health Insurance Review and Assessment 2009

33 신삼철, "7개 질병군 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험" 한국보건행정학회 23 (23): 103-111, 2013