The Effect of Reform of New-Diagnosis Related Groups (KDRGs) on Accuracy of Payment

신포괄수가 시범사업 모형 개선 이후의 지불정확도 변화

  • 최정규 (국민건강보험 일산병원) ;
  • 김선희 (국민건강보험 일산병원) ;
  • 신동교 (국민건강보험 일산병원) ;
  • 강중구 (국민건강보험 일산병원)
  • Received : 2017.04.03
  • Accepted : 2017.06.22
  • Published : 2017.09.30


Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.


  1. Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Case mix definition by diagnosis-related groups. Med Care 1980;18(2 Suppl):1-53.
  2. Busse R, Schreyogg J, Smith PC. Hospital case payment systems in Europe. Health Care Manag Sci 2006;9(3):211-213.
  3. Schreyogg J, Stargardt T, Tiemann O, Busse R. Methods to determine reimbursement rates for diagnosis related groups (DRG): a comparison of nine European countries. Health Care Manag Sci 2006;9(3):215-223. DOI:
  4. Kim Y. A study on improvement of neo-diagnosis related groups (KDRGs). Wonju: Health Insurance Review and Assessment Service; 2015.
  5. Yun PK, Kang JG, Sun YK, You CH, Shin DG, Tae ES, A detailed analysis of neo-diagnosis related groups (KDRGs) expense. Goyang: National Health Insurance Service Ilsan Hospital; 2012.
  6. Shin DG, Kim SH, Lee CK, Yang KH, Park EC, Kang JG. Evaluation of demonstration project about neo-diagnosis related groups (KDRGs). Goyang: National Health Insurance Service Ilsan Hospital; 2014.
  7. Joung ES, Tae YH, Choi YS. Effect of neo-diagnosis related groups (KDRGs) on coverage and finance of national health insurance. Wonju: National Health Insurance Service; 2015.
  8. Kim JH, Lee KT. Factors causing the difference of product costs under a traditional costing system and an ABC systems. Korean J Manag Account Res 2003;3(2):97-117.
  9. Cho YJ, Paik TY. A case study of a Korean Bank’s activity-based costing. Korean J Manag Account Res 2003;3(2):1-25.
  10. Park GS, Lee JB. The effect of activity-based costing on strategic decisions. Korean J Bus Adm 2005;18(6):2829-2852.
  11. Simborg DW. DRG creep: a new hospital-acquired disease. N Engl J Med 1981;304(26):1602-1604. DOI:
  12. Steinbusch PJ, Oostenbrink JB, Zuurbier JJ, Schaepkens FJ. The risk of upcoding in casemix systems: a comparative study. Health Policy 2007;81(2-3):289-299. DOI:
  13. Silverman E, Skinner J. Medicare upcoding and hospital ownership. J Health Econ 2004;23(2):369-389. DOI:
  14. Newhouse JP, Byrne DJ. Did Medicare's prospective payment system cause length of stay to fall? J Health Econ 1988;7(4):413-416. DOI:
  15. Ellis RP. Creaming, skimping and dumping: provider competition on the intensive and extensive margins. J Health Econ 1998;17(5):537-555. DOI:
  16. Kang G. The necessity and meaning of neo-diagnosis related groups (KDRGs) introduction. HIRA Policy Trend 2009;3(2):8-12.
  17. Schuster M, Kuntz L, Hermening D, Bauer M, Abel K, Goetz AE. The use of diagnosis-related-groups data for external benchmarking of anesthesia and intensive care services. Anaesthesist 2006;55(1):26-32.
  18. Van de Ven WP, Schut FT. Managed competition in the Netherlands: still work-in-progress. Health Econ 2009;18(3):253-255. DOI:
  19. 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.
  20. McCrone P, Phelan M. Diagnosis and length of psychiatric in-patient stay. Psychol Med 1994;24(4):1025-1030. DOI:
  21. Lave JR. Developing a Medicare prospective payment system for inpatient psychiatric care. Health Aff (Millwood) 2003;22(5):97-109. DOI:
  22. Jackson T. Cost estimates for hospital inpatient care in Australia: evaluation of alternative sources. Aust N Z J Public Health 2000;24(3):234-241. DOI:
  23. Shon C, Kwon S, You M. Policy elites' perception of health policy governance: findings from in-depth interviews of Korean new diagnosis related group payment. Health Policy Manag, 2013;23(4):326-342. DOI:
  24. Jeong HS, Cho L. Expansion of Japan's DPC and its lesson for Korea. Korean J Health Econ Policy 2013;19(2):39-60.