DOI QR코드

DOI QR Code

중증도 분류에 따른 진료비 차이: 간질환을 중심으로

신동교;이천균;이상규;강중구;선영규;박은철
Shin, Dong Gyo;Lee, Chun Kyoon;Lee, Sang Gyu;Kang, Jung Gu;Sun, Young Kyu;Park, Eun-Cheol

  • 투고 : 2012.08.27
  • 심사 : 2013.02.14
  • 발행 : 2013.03.31

초록

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

키워드

Diagnosis procedure combination;Diagnosis related group;Severity;Model of end-stage liver disease score

참고문헌

  1. Busse R, Geissler A, Quentin W, Wiley M. Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. Maidenhead: Open University Press; 2011.
  2. Choi H, Lee C, Shin D. Collection of clinical activity related data and validity analysis on pilot KDRG groups using data collected. J Ilsan Hosp 2010;9: 117-127.
  3. do Nascimento EM, Pereira Bde B, Basto ST, Ribeiro Filho J. Survival tree and MELD to predict long term survival in liver transplantation waiting list. J Med Syst 2012;36(1):73-78. https://doi.org/10.1007/s10916-010-9447-6
  4. Freeman JL, Fetter RB, Park H, Schneider KC, Lichtenstein JL, Hughes JS, et al. Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications. Med Care 1995;33:806-827. https://doi.org/10.1097/00005650-199508000-00006
  5. Gilman BH. Hospital response to DRG refinements: the impact of multiple reimbursement incentives on inpatient length of stay. Health Econ 2000; 9(4):277-294. https://doi.org/10.1002/1099-1050(200006)9:4<277::AID-HEC513>3.0.CO;2-1
  6. Health Insurance Review and Assessment Service. KDRG catalogue version 3.2. Seoul: Health Insurance Review and Assessment Service; 2008.
  7. Igatutushinsya. DPC score catalogue version 2010. 4.
  8. Jung HS. Investigational research on Japanese DPC. Goyang: National Health Insurance Corporation Ilsan Hospital; 2012.
  9. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464-470. https://doi.org/10.1053/jhep.2001.22172
  10. Kang GW, Park H, Shin YS. Refinement and evaluation of Korean diagnosis related group. Korean J Health Policy Adm 2004;14(1):121-147. https://doi.org/10.4332/KJHPA.2004.14.1.121
  11. Lee KS, Kang HC, Nam CM, Cho W, Kang HY. Variations in hospital length of stay for diagnosis-related groups among health care institutions. Korean J Health Policy Adm 2006;16(2):77-95. https://doi.org/10.4332/KJHPA.2006.16.2.077
  12. Lee SH, Choi KS, Jo HS, Chae YM, Han EA. A critical review of the application experiences of the DRG reimbursement system in the USA. Korean J Health Policy Adm 2000;10(4):20-56.
  13. Papatheodoridis GV, Cholongitas E, Dimitriadou E, Touloumi G, Sevastianos V, Archimandritis AJ. MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis. World J Gastroenterol 2005;11(20):3099-3104. https://doi.org/10.3748/wjg.v11.i20.3099
  14. Park EC, Lee SH, Lee SG. The U.S. experience of the DRG payment system and suggestions to Korea. Korean J Hosp Manag 2002;7(1):105-120.
  15. Rosina F, Alaria P, Castelli S, Dirindin N, Rocca G, Actis GC, et al. Effect of patient characteristics on hospital costs for cirrhosis: implications for the disease-related group (DRG) reimbursement system. Ital J Gastroenterol 1996;28(7):401-405.
  16. Ryu S, Park EC. Social security in health care. Seoul: Shinkwang; 2009.
  17. Shin YS, Lee YS, Park HY, Yeom YK. Development and evaluation of Korean diagnosis related groups: medical service utilization of inpatients. Korean J Prev Med 1993;26(2):293-309.
  18. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124(1):91-96. https://doi.org/10.1053/gast.2003.50016
  19. Yoon P, Kang J, Sun Y, Ryu C, Shin D, Tae E. Detailed analysis of medical charges on new Korean DRG: main results of demonstration projects for 2nd pilot project of new Korean DRG payment system. Goyang: Research Institute of Ilsan Hospital; 2012.