포괄수가제도 당연적용 효과평가

최재우; 장성인; 장석용; 김승주; 박혜기; 김태현; 박은철

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자료유형: 학술저널

저자정보: 최재우 (연세대학교 대학원 보건학과) 장성인 (연세대학교 보건정책 및 관리연구소) 장석용 (연세대학교 보건정책 및 관리연구소) 김승주 (연세대학교 대학원 보건학과) 박혜기 (연세대학교 대학원 보건학과) 김태현 (연세대학교 보건정책 및 관리연구소) 박은철 (연세대학교 보건정책 및 관리연구소)

저널정보: 한국보건행정학회 보건행정학회지 보건행정학회지 제26권 제2호

발행연도: 2016.1

수록면: 135 - 147 (13page)

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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.

#Diagnosis-related groups #Length of stay #Health care costs #Outpatient health services #Patient readmission

참고문헌 (33)

참고문헌 신청

최재우 / 2015 / 우리나라 국민건강보험제도의 보험료 부담 형평성에 관한 연구 / 보건사회연구 35(3):199~221

Choi BH / 1999 / Management experience for DRG-PPS in the U.S. and evaluation for DRG demonstration project in Korea / Korean Health Econ Rev 5:133~154

신삼철 / 2013 / 7개 질병군 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험 / 보건행정학회지 23(2):103~111

Kwon S / 2003 / Payment system reform for health care providers in Korea / Health Policy Plan 18(1):84~92

박은철 / 2002 / DRG 지불제도에 대한 미국의 경험과 우리나라에의 시사점 / 병원경영학회지 7(1):105~120

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