Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Variation in hospital length of stay according to the DRG-based prospective payment system in the voluntarily participating providers

DRG(Diagnosis-Related Group)를 이용한 포괄진료비 지불제도의 선택 참여에 따른 재원일수 변화

  • Choi, Sook-Ja (Graduate School of Public Health, Seoul National University) ;
  • Kwon, Soon-Man (Graduate School of Public Health, Seoul National University) ;
  • Kang, Gil-Won (Department of Health Informatics and Management, College of Medicine, Chungbuk National University) ;
  • Moon, Sang-Jun (Department of Health Policy and Management, College of Medicine, Seoul National University(Institute of Health Policy and Management)) ;
  • Lee, Jin-Seok (Department of Health Policy and Management, College of Medicine, Seoul National University(Institute of Health Policy and Management))
  • 최숙자 (서울대학교 보건대학원) ;
  • 권순만 (서울대학교 보건대학원) ;
  • 강길원 (충북대학교 의과대학 의료정보학및관리학교실) ;
  • 문상준 (서울대학교 의과대학 의료관리학교실, 의료관리학연구소) ;
  • 이진석 (서울대학교 의과대학 의료관리학교실, 의료관리학연구소)
  • Received : 2009.11.25
  • Accepted : 2010.03.02
  • Published : 2010.06.30
Download PDF
⟨ Previous Next ⟩

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 according to 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.

Keywords

References

  1. 김진현. DRG지불제도 시범사업의 재평가-평가방법론을 중심으로, 보건경제연구, 2002 ; 8(1) : 59-89.
  2. 김창엽. 건강보장의 이론. 한울아카데미. 2009.
  3. 김창엽, 이영성, 윤석준, 이원영, 임정수, 권영훈, 박형근 등. DRG 지불제도 시범사업 평가 및 개선방안 연구-제도.정책적 측면을 중심으로. 서울 : 보건복지부·서울대학교 의과대학 ; 2000.
  4. 문옥륜, 신영전, 강길원, 이성천, 신상진, 전종한, 김화준 등. 진료비 지불제도의 장기적 개선. 서울 : 요양급여비용연구기획단. 2006.
  5. 변재환, 조우현, 박웅섭, 박은철, 송정흠, 이선희, 이윤환 등. DRG 지불제도의 문제점과 정책개선방안. 서울 : 한국병원경영연구원 ; 2000.12.
  6. 이기성, 강희정, 남정모, 조우현, 강혜영. DRG 지불제도 참여기관의 재원일수 변이에 관한 연구, 보건행정학회지, 2006 ; 16(2) : 77-95. https://doi.org/10.4332/KJHPA.2006.16.2.077
  7. 이선희, 최귀선, 조희숙, 채유미, 한은아. DRG에 의한 포괄수가제 적용경험의 연구동향 분석 -DRG 제도에 대한 비판적 관점에서-, 보건행정학회지 2000 ; 10(4) : 20-56.
  8. Burns LR, Wholey DR, The effects of patient, hospital, and physician characteristics on length of stay and mortality, Medical care, 1991 ; 29(3) : 251-271. https://doi.org/10.1097/00005650-199103000-00007
  9. Chulis, G.S., Assessing Medicare's prospective payment system for hospitals, Medical Care Review 1991 ; 48 : 167-206. https://doi.org/10.1177/002570879104800203
  10. Davis, C.K. and Rhodes, D.J., The impact of DRGs on the cost and quality of health care in the United States, Health Policy 1988 ; 9 : 117-131. https://doi.org/10.1016/0168-8510(88)90029-2
  11. Ellis RP & McGuire TG. Hospital response to prospective payment: Moral hazard, selection, and practice-style effects, Journal of Health Economics, 1996 ; 15 : 257-277. https://doi.org/10.1016/0167-6296(96)00002-1
  12. Epstein AM, Bogen J, Dreyer P, and Thorpe KE, Trends in lehgth of stay and rates of readmission in Massachusetts : implications for monitoring quality of care, Inquiry, 1991 ; 28 : 19-28.
  13. Frank, RG, Lave JR, Taube CA, Rupp A, and Goldman HH. The impact of Medicare's propspective payment system on psychiatric patients treated in scatterbeds, NERA Working paper, No.2030, 1986.
  14. Hayward RA, Manning WG Jr, McMahon LF Jr, Bernard AM. Do attending or resident physician practice styles account for variations in hospital resource use? Medical care, 1994 ; 32(8) : 788-794. https://doi.org/10.1097/00005650-199408000-00003
  15. Hemenway D, Kellen A. Cashman S.B., Parks C.L., and Bicknell W.J., Physicians' responses to financial incentives : evidence from a for-profit ambulatory care center, New England Journal of Medicine, 1990;322(15) : 1059-63. https://doi.org/10.1056/NEJM199004123221507
  16. Hillman A.L., Pauly M.V. and Kerstein J.J. How do financial incentives affect physicians' clinical decisions and the financial performance of Health Maintenance Organizations?, New England Journal of Medicine, 1989 ; 321(2) : 86-92. https://doi.org/10.1056/NEJM198907133210205
  17. Kominski G. and Witsberger C. Trends in LOS for Medicare patients : 1979-1987, Health Care Financing Review, 1993 ; 15(2) : 121-135.
  18. Krasnik A., Groenewegen P.P., Pedersen P.A., Scholten P., Mooney G., and Gottschau A. et al., Changing remuneration systems : effects on activity in general practice, British Medical Journal, 1990 ; 300 : 1698-701. https://doi.org/10.1136/bmj.300.6741.1698
  19. Lave JR, Leinhardt S. An evaluation of a hospital stay regulatory mechanism. American Journal of Public Health, 1976 ; 66(1) : 959-67. https://doi.org/10.2105/AJPH.66.10.959
  20. Liu Y, Philips M, and Codde J., Factors influencing patients' length of stay, Australian Health Review 2001 ; 24(2) : 63-70. https://doi.org/10.1071/AH010063
  21. Monrad Aas I.H., Incentive and financing methods, Health Policy, 1995 ; 34 : 205-220. https://doi.org/10.1016/0168-8510(95)00759-8
  22. Newhouse J.P., Byrne D.J., Did Medicare prospective payment system cause length of stay to fall?, Journal of Health Economics, 1988 ; 7 : 837-853.
  23. Norton EC, Van Houtven CH, Lindrooth RC, Normand ST, and Dickey B. Does prospective payment reduce inpatient length of stay?, Health Economics, 2002 ; 11 : 377-387. https://doi.org/10.1002/hec.675
  24. Schwartz, W.B. and Mendelson, D.N., Hospital cost containment in the 1980s : hard lessons learned and prospects for the 1990s, New England Journal of Medicine, 1991 ; 324 : 1037-42. https://doi.org/10.1056/NEJM199104113241506
  25. Shumueli A. Intrator O, and Israeli 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, Social Science & Medicine, 2002 ; 55 : 981-989. https://doi.org/10.1016/S0277-9536(01)00233-7
  26. Sloan, F.A., Morrison, E.M. and Valvona, J., Effects of the Medicare prospective payment system on hospital cost containment : an early appraisal, Milbank Quarterly, 1988 ; 66 : 191-217. https://doi.org/10.2307/3350030
  27. Thompson, J.D., DRG prepayment : its purpose and performance, Bulletin of the New York Academy of Medicine, 1988 ; 64 : 28-51.
  28. Westert GP., Nieboer AP, and Groenewegen PP., Variation in duration of hospital stay between hospitals and between doctors within hospitals, Social Science & Medicine, 1993 ; 37(6) : 833-839. https://doi.org/10.1016/0277-9536(93)90377-G

Cited by

  1. Simulation on the Change of Practice Pattern after the Introduction of 7 Diagnosis-related Groups Prospective Payment System in a University Hospital vol.23, pp.2, 2013, https://doi.org/10.4332/KJHPA.2013.23.2.103
  2. The Development of Convergence Bench-making system on length of stay vol.13, pp.5, 2015, https://doi.org/10.14400/JDC.2015.13.5.89
  3. The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea vol.26, pp.1, 2015, https://doi.org/10.1093/eurpub/ckv162
  4. The Effect of Mandatory Diagnosis-Related Groups Payment System vol.26, pp.2, 2016, https://doi.org/10.4332/KJHPA.2016.26.2.135
  5. 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 pp.00179124, 2018, https://doi.org/10.1111/1475-6773.12749