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English Abstract
- Impact of DRG Payment on the Length of Stay and the Number of Outpatient Visits After Discharge for Caesarean Section During 2004-2007.
- Changwoo Shon, Seolhee Chung, Seonju Yi, Soonman Kwon
- J Prev Med Public Health. 2011;44(1):48-55.
- DOI: https://doi.org/10.3961/jpmph.2011.44.1.48
- 5,954 View
- 162 Download
- 9 Crossref
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Abstract
PDF - OBJECTIVES
The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. METHODS: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. RESULTS: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. CONCLUSIONS: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program. -
Summary
Citations
Citations to this article as recorded by
- The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis
Zhaolin Meng, Wen Hui, Yuanyi Cai, Jiazhou Liu, Huazhang Wu
Health Policy.2020; 124(4): 359. CrossRef - Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data
Jae Woo Choi, Seung-Ju Kim, Hye-Ki Park, Sung-In Jang, Tae Hyun Kim, Eun-Cheol Park
BMC Health Services Research.2019;[Epub] CrossRef - Early Impact on Outpatients of Mandatory Adoption of the Diagnosis‐Related Group‐Based Reimbursement System in Korea on Use of Outpatient Care: Differences in Medical Utilization and Presurgery Examination
Seung Ju Kim, Kyu‐Tae Han, Woorim Kim, Sun Jung Kim, Eun‐Cheol Park
Health Services Research.2018; 53(4): 2064. CrossRef - The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea
Seung Ju Kim, Eun-Cheol Park, Sun Jung Kim, Kyu-Tae Han, Euna Han, Sung-In Jang, Tae Hyun Kim
The European Journal of Public Health.2016; 26(1): 42. CrossRef - Impact of payment system change from per-case to per-diem on high severity patient's length of stay
Sung-In Jang, Chung Mo Nam, Sang Gyu Lee, Tae Hyun Kim, Sohee Park, Eun-Cheol Park
Medicine.2016; 95(37): e4839. CrossRef - The Effect of Mandatory Diagnosis-Related Groups Payment System
Jae-Woo Choi, Sung-In Jang, Suk-Yong Jang, Seung-Ju Kim, Hye-Ki Park, Tae Hyun Kim, Eun-Cheol Park
Health Policy and Management.2016; 26(2): 135. CrossRef - Is the Hospital Caseload of Diagnosis Related Groups Related to Medical Charges and Length of Stay?
Jin-Mi Kwak, Kwang-Soo Lee
The Korean Journal of Health Service Management.2014; 8(4): 13. CrossRef - Perspectives on cost containment and quality of health care in the DRG payment system of Korea
Jaewook Choi
Journal of the Korean Medical Association.2012; 55(8): 706. CrossRef - Nurses' Cognition of Diagnosis Related Group (DRG) in Long-term Care Hospitals and Changes in Nursing Care after Application of DRG
Eun Ha, Kyeha Kim
Journal of Korean Academy of Nursing Administration.2012; 18(2): 176. CrossRef
Original Articles- Impacts of DRG Payment System on Behavior of Medical Insurance Claimants.
- Beom Man Ha, Gilwon Kang, Hyoung Keun Park, Chang Yup Kim, Yong Ik Kim
- Korean J Prev Med. 2000;33(4):393-401.
- 2,455 View
- 31 Download
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Abstract
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- OBJECTIVES
To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. METHODS: In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. RESULTS: The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.9% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). CONCLUSIONS: After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed. -
SummaryTOP
- Impacts of the Implementation of the DRG Based Prospective Payment System on the Medicare Expenditures.
- Han Joong Kim, Chung Mo Nam
- Korean J Prev Med. 1994;27(1):107-116.
- 2,307 View
- 21 Download
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Abstract
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- The united states adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses: (l) The PPS decelerated the increase in the hospital expenditure (part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the part A expenditure were greater than losses in the part B expenditure. The dependent variables are per capita hospital expenditure, per capita part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows: (l) The annual increase in the per capita part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significant (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita part B expenditure was accelerated by $l.73 (t=l.91) after the implementation of the PPS. (3) The increase in the total Medicine expenditure per capita was reduced by $4.26(t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.
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Summary
- Development And Evaluation Of Korean Diagnosis Related Groups: Medical Service Utilization Of Inpatients.
- Young Soo Shin, Young Seong Lee, Ha Young Park, Yong Kwon Yeom
- Korean J Prev Med. 1993;26(2):293-309.
- 2,297 View
- 55 Download
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Abstract
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- With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U. S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U. S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the difference in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated for its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed ad payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U. S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.
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Summary
- A Study on the Regional Function of Health Care by the Disease Pattern of the Inpatients.
- Huyn Rim Choi, Sang Il Lee, Young Soo Shin, Yong Ik Kim
- Korean J Prev Med. 1988;21(2):390-403.
- 2,175 View
- 19 Download
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Abstract
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- The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and countries were classified into 5 district groups by factor analysis results of K-DRGs. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct functional district groups. Group A(18 district) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns ; inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaders, but Group C and D were inflow or outflow types according to the disease tracers.
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