DRG(Diagnosis-Related Group)를 이용한 포괄진료비 지불제도의 선택 참여에 따른 재원일수 변화 = Variation in hospital length of stay according to the DRG-based prospective payment system in the voluntarily participating providers

다국어 초록 (Multilingual Abstract)

This study explored the impact on the DRG(Diagnosis-Related Groups)-based prospective payment system(PPS) operated by voluntarily participation providers.
We analyzed whether the provides in the DRG-based PPS and in traditional fee-for-service(FFS) systems showed different the degree of variation in length of stay(LOS), and the providers' behaviors depending on the differences accordingto the varied participation periods.
The study sample included all data 2,061 institutions participated in DRG-PPS in 2007 and all cases 473 FFS institutions which reported fee-for-service claims were reviewed same diagnosized diseases at least 10cases claims during three months We compared the differences of the LOS among health care institutions according to their type, region, and size. For DRGs showing significant differences in LOS, multiple regression analyses were performed to find out factors associated with LOS and interaction effect participation and hospital types or participation periods.
The result provide the evidence that the DRG payment system operated by volunteering health care institutions had impact on resources use, which can reduce the institutions' the length of stay. While some DRGs had no correlation between participation periods and LOS, other DRGs, DRG participation period reversely linear relationship with LOS. That is to say, the longer participation year, the less reducing the LOS. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

참고문헌 (Reference)

1 문옥륜, "진료비 지불제도의 장기적 개선" 요양급여비용연구기획단 2006

2 김창엽, "건강보장의 이론" 한울아카데미 2009

3 Westert GP, "Variation in duration of hospital stay between hospitals and between doctors within hospitals" 37 (37): 833-839, 1993

4 Epstein AM, "Trends in lehgth of stay and rates of readmission in Massachusetts : implications for monitoring quality of care" 28 : 19-28, 1991

5 Kominski G, "Trends in LOS for Medicare patients : 1979-1987" 15 (15): 121-135, 1993

6 Frank, RG, "The impact of Medicare's propspective payment system on psychiatric patients treated in scatterbeds" No.2030 1986

7 Davis, C.K, "The impact of DRGs on the cost and quality of health care in the United States" 9 : 117-131, 1988

8 Burns LR, "The effects of patient, hospital, and physician characteristics on length of stay and mortality" 29 (29): 251-271, 1991

9 Shumueli A, "The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income : the early experience of Israel" 55 : 981-989, 2002

10 Hemenway D, "Physicians'responses to financial incentives : evidence from a for-profit ambulatory care center" 322 (322): 1059-63, 1990

11 Monrad Aas I.H, "Incentive and financing methods" 34 : 205-220, 1995

12 Hillman A.L, "How do financial incentives affect physicians' clinical decisions and the financial performance of Health Maintenance Organizations?" 321 (321): 86-92, 1989

13 Ellis RP, "Hospital response to prospective payment: Moral hazard,selection, and practice-style effects" 15 : 257-277, 1996

14 Schwartz, W.B, "Hospital cost containment in the 1980s : hard lessons learned and prospects for the 1990s" 324 : 1037-42, 1991

15 Liu Y, "Factors influencing patients' length of stay" 24 (24): 63-70, 2001

16 Sloan, F.A, "Effects of the Medicare prospective payment system on hospital cost containment : an early appraisal" 66 : 191-217, 1988

17 Norton EC, "Does prospective payment reduce inpatient length of stay?" 11 : 377-387, 2002

18 Hayward RA, "Do attending or resident physician practice styles account for variations in hospital resource use?" 32 (32): 788-794, 1994

19 Newhouse J.P, "Did Medicare prospective payment system cause length of stay to fall?" 7 : 837-853, 1988

20 김진현, "DRG지불제도 시범사업의 재평가-평가방법론을 중심으로" 8 (8): 59-89, 2002

21 이선희, "DRG에 의한 포괄수가제 적용경험의 연구동향 분석-DRG 제도에 대한 비판적 관점에서-" 10 (10): 20-56, 2000

22 변재환, "DRG 지불제도의 문제점과 정책개선방안" 한국병원경영연구원 2000

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

24 김창엽, "DRG 지불제도 시범사업 평가및 개선방안 연구-제도·정책적 측면을 중심으로" 보건복지부·서울대학교 의과대학 2000

25 Thompson, J.D, "DRG prepayment : its purpose and performance" 64 : 28-51, 1988

26 Krasnik A, "Changing remuneration systems : effects on activity in general practice" 300 : 1698-701, 1990

27 Chulis, G.S, "Assessing Medicare's prospective payment system for hospitals" 48 : 167-206, 1991

28 Lave JR, "An evaluation of a hospital stay regulatory mechanism" 66 (66): 959-67, 1976