건강보험 심사평가원 자료로 본 Diagnosis Related Group 시행 후 편도적출수술 청구 비용의 변화 평가

이형주; 임채동; 원성준; 김진평; 박정제; 우승훈

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자료유형: 학술저널

저자정보: 이형주 임채동 원성준 김진평 박정제 우승훈

저널정보: 대한이비인후과학회 대한이비인후-두경부외과학회지 대한이비인후과학회지 두경부외과학 제59권 제9호

발행연도: 2016.1

수록면: 661 - 667 (7page)

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Background and Objectives Diagnosis by Related Groups (DRG), a system forcibly implemented in all medical institutions from July 2013, was applied to tonsillectomy and adenoidectomy in the field of Otorhinolaryngology. We analyzed the changes in medical costs and evaluated the efficiency of the DRG system by analyzing the data collected before and after the DRG implementation. Materials and Method We analyzed the total number of cases, total medical costs and per charge for tonsillectomy and adenoidectomy using the data from the Korean National Health Insurance from 2011 to 2014. We compared the number and cost of tonsillectomy and adenoidectomy by hospital type, region, and patient age. Results The total number of tonsillectomy and adenoidectomy after the application of DRG systems in July 2013 in all medical institutions was reduced, but the total costs showed a tendancy to increase, resulting in an increase per charge of case. The number of tonsillectomy and adenoidectomy was decreased in general and specialized hospitals, but the costs were increased after DRG systems. Conclusion Medical costs per charge of case related to tonsillectomy and adenoidectomy was higher in the DRG system than in the ‘fee for service’ system. Increased medical costs, considered to be the most likely cause of patient copayments, are recognized in the DRG system. The results showed that saving effect of medical costs was not significant in the DRG system; it may appear to relieve patient burden in the short term, but the financial state of national health insurance is worsening. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(9):661-7

#Adenoidectomy ㆍDiagnosis by Related Groups ㆍMedical costs ㆍTonsillectomy.

참고문헌 (20)

참고문헌 신청

Park BW / 2013 / A Study on the noncompliance of D.R.G

Chung EY / 2014 / Impact of Mandatory DRG payment system on Medical cost and Length of Stay

OECD / 2013 / OECD Review of Health Care Quality: Korea-Raising Standards / OECD publishing

Burns LR / 1991 / The effects of patient, hospital, and physician characteristics on length of stay and mortality / Med Care 29(3):251~271

Rogers WH / 1990 / Quality of care before and after implementation of the DRG-based prospective payment system. A summary of effects / JAMA 264(15):1989~1994

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