Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Evaluation of the Homogeneity of Korean Diagnosis Related Groups

한국형진단명기준환자군 분류체계의 동질성 평가

  • Kim, Hyung Seon (Health Insurance Review and Assessment Service) ;
  • Lee, Sun Hee (Department of Preventive Medicine, Ewha Womans University School of Medicine) ;
  • Nam, Chung Mo (Department of Preventive Medicine, Yonsei University College of Medicine)
  • 김형선 (건강보험심사평가원) ;
  • 이선희 (이화여자대학교 의과대학 예방의학교실) ;
  • 남정모 (연세대학교 의과대학 예방의학교실)
  • Received : 2012.11.22
  • Accepted : 2013.02.06
  • Published : 2013.03.31
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Abstract

Background: This study designed to evaluate the homogeneity of Korean diagnosis related group (KDRG) version 3.4 classification system. Methods: The total 5,921,873 claims data submitted to the Health Insurance Review and Assessment Service during 2010 were used. Both coefficient of variation (CV) and reduction in variance of cost were measured for evaluation. This analysis was divided into before and after trimming outliers at the level of adjacent DRG (ADRG), aged ADRG (AADRG) split by age, and DRG split by complication and comorbidity. Results: At the each three level of ADRG, AADRG, and DRG, there were 38.9%, 38.7%, and 30.0% of which had a CV > 100% in the untrimmed data and there were 1.4%, 1.4%, and 1.9% in the trimmed one. Before trimming outliers, ADRGs explained 52.5% of the variability in resource use, AADRGs did 53.1% and DRGs did 57.1%. The additional explanatory power by age and comorbidity and complication (CC) split were 0.6%p and 4.6%p for each, which were statistically significant. After trimming outliers, ADRGs explained 75.2% of the variability in resource use, AADRGs did 75.6%, and DRGs did 77.1%. The additional explanatory power were 0.4%p and 2.0%p for each, which were statistically significant too. Conclusion: The results demonstrated that KDRG showed high homogeneity within groups and performance after trimming outliers. But there were DRGs CV > 100% after age or CC split and the most contributing factor to high performance of KDRG was the ADRG rather than age or CC split. Therefore, it is recommended that the efforts for improving clinical homogeneity of KDRG such as review of the hierarchical structure of classification systems and classification variables.

Keywords

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