보건행정학회지 (Health Policy and Management)

  • 제10권4호
  • /
  • Pages.20-56
  • /
  • 2000
  • /
  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지

DRG에 의한 포괄수가제 적용경험의 연구동향 분석 - DRG 제도에 대한 비판적 관점에서 -

A Critical Review of the Application Experiences of the DRG Reimbursement System in the USA

  • 이선희 (이화여자대학교 의과대학 예방의학교실) ;
  • 최귀선 (이화여자대학교 의과대학 예방의학교실) ;
  • 조희숙 (이화여자대학교 의과대학 예방의학교실) ;
  • 채유미 (이화여자대학교 의과대학 예방의학교실) ;
  • 한은아 (한국보건사회연구원)
  • 발행 : 2000.12.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

키워드

참고문헌

  1. 포괄수가제 개발 및 실용화 방안연구 김일순;김한중(외)
  2. 보건행정학회 전기학술대회 연제집 DRG 지불제도 시범사업과 병원관리 박하영
  3. DRG 지불제도 시범사업 제2차년도 평가 및 3차년도 실시 방안 연구 보건복지부;한국보건산업진흥원
  4. 보건사회연구 v.18 no.2 DRG분류에 의한 선지불제도 고찰 최병호
  5. DRG지불제도 시범사업 제1차년도 평가 및 2차년도실시방안 연구 한국보건의료연구원
  6. 시범사업 대상 DRG별 진료비 분석 함옥경
  7. Health Affaris v.4 no.3 Prospective payment : the next big policy disappointment? Aaron HJ
  8. Harvard Business Review Hospital cost control ; a bitter pill to swallow Aaron HJ;Schwartz WB
  9. N Eng J Med v.329 no.13 Possible influence of the prospective payment system on the assignment of the discharge diagnoses for coronary heart disease Assaf AR;Lapane KL;Mckenney JL;Carleton RA
  10. Med Care v.22 no.2 Length of stay variations within ICD-8 Diagnosis related groups Berki SE;Ashcraft M;Newbrander W
  11. Health Care Mang Rev v.19 no.1 An examination of winners and losers under Medicare PPS Bray N;Carter C;Dobson A;Watt JM:Shortell S
  12. American Journal of Hospital Pharmacy v.47 no.1 Effect of the prospective-pricing system on drug use in Pennsylvania long-term-care facilities Carroll NV;Erwin WG
  13. Med Care v.25 Patient shifting as a response to Medicare prospective payment Carroll NV;Erwin WG
  14. Med Care Rev. v.48 no.2 Assessing Medicare's prospective payment system for hopitals Chulis GS
  15. Health Serv Res v.28 no.1 Effect of prospective reimbursement on nursing home costs Coburn AF
  16. Health Policy v.9 The impact of DRGs on the cost and quality of health care in the United States Davis CK;Rhodes D
  17. Inquiry v.24 no.1 The early effects of the prospective payment system on patient utilization and quality of care DesHarais S;Kobrinski E;Chesney J;Long M;Ament R;Fleming S
  18. Health Care Financ Rev v.16 no.2 Refinement of the Medicare diagnosis-raleted groups to incorporate a measure severity Edwards N;Honemann D;Burley D;Navarro M
  19. Health Care Financ Rev no.SUP. Prospective payment system and quality : early results and research strategy Eggers PW
  20. Issues Sci Technol v.1 no.1 Prospective payment : Will it solve Medicare's financial problem? Entoven AC;Noll RG
  21. Inquiry v.28 Trends in length of stay and rates of readmission in Massachusetts: Implication for monitroing quality of care Epstein AM;Bogen J;Dreyer P;Thorpe KE
  22. Health Care Financ Rev v.18 Impact of the prospective payment system on physician charges under Medicare Fisher CR
  23. JAMA v.258 Changing patterns of hip fracture care before and after implementation of the prospective payment system Fitzgerald JF;Fagan LF;Tiemey WM;Dittus RS
  24. Soc Sci Med v.31 no.10 Regualation, retrenchment - the DRG experience : problems from changing reimbursement practice Gay EG;Kronenfeld JJ
  25. N Engl J Med v.319 no.21 The care of elderly patients with hip fracture-changes since implementation of the prospective payment system Fitzgerald JF;Moore PS;Dittus RS
  26. Health Care Financ Rev v.12 no.2 PPS and other effects on post-hospital services Gianfrancesco FD
  27. Health Serv Res v.25 no.1 The fairness of the PPS reimbursement methodology Gianfrancesco FD
  28. Health Care Financ Rev v.7 no.2 Medicare case-mix increase Ginsburg PB;Carter GM
  29. Health Serv Res v.27 no.3 Changes in the Medicare case-mix index in the 1980s and effect of the prospective payment system Goldfarb MG;Coffey R
  30. Health Affair Hosptial's financial performance in the first five years of PPS Guterman, S;Altman SH;Young DA
  31. Health Care Financing Review v.7 no.3 Impact of the Medicare Prospective payment system for hospital Guterman, S;Dobson A
  32. Am J Pub Health v.80 no.12 Prospective payment and the utilization of physical therapy service in the hospitalized elderly Holt P;Winograd CH
  33. N Engl J Med v.313 no.1 Interhospital differences in severity of illness: problems for prospective payment based on DRGS Horn SD;Bulkley G;Sharkey PD;Chambers AF;Horn RA;Schramm CJ
  34. N Engl J Med v.318 no.6 Accuracy of diagnostic coding for Medicare patients under the prospective payment system Hsia DC;Krushat M;Fagan AB;Tebbutt JA; Kusserow RP
  35. Inquiry v.24 The impact of DRG payment on New Jersey hospital Hsiao WC;Dunn D
  36. Health Affairs v.5 Lseeons of New Jersey DRG payment system Hsiao WC;Sapolsky HM:Dunn DL;Weiner SL
  37. Health Serv Res v.26 no.5 Uncompensated care before and after PPS: the role of hospital location and ownership Hultman CI
  38. JAMA v.264 no.15 Comparing outcomes of care before and after implementation of the DRG-based prospective payment system Kahn KL;Keeler EB;Sherwood MJ;Rogers WH;Draper D(et al.)
  39. New Eng J Med v.321 no.16 The effects of the Medicare PPS on the adoption of new technology Kane NM;Manoukian PD
  40. JAMA v.264 no.15 Changes in sickness at admission following the introduction of the prospective payment system Keeler EB;Kahn KL:Draper D(et al.)
  41. Healthe Care Financing Review v.15 no.2 Trends in LOS for Medicare patients: 1979-1987 Kominski G;Witsberger C
  42. Med Care v.31 no.3 Change in follow-up care for Medicare surgical patients under PPS Kominski GF;Biddle AK
  43. Am Geri Soc v.39 no.8 Trends in elderly hospitalization and readmission rates for a geographically defined population:pre-and post-prospective payment Leinbson CL;Naessens JM;Campion ME;Krishan I;Bllard D
  44. Am J Pub Health v.77 no.7 The initial effect of prospective payment system on nursing home patient Lewis MA;Leak B;Leah-Satelo M;Clark V
  45. Med Care v.27 no.5 Refinding DRGs : the example of children's diagnosis-related groups Lichtig L;Kanuf RA;Parrott RH;Muldoon J
  46. Med Care v.25 no.6 The effects of the prospective payment system on hospital product and productivity Long MJ;Chesney JD;Ament RP;Desharnais SI;Fleming ST;Kobrinski EJ;Marshall BS
  47. Health Care Financ Rev v.8 no.1 Should children's hospitals have special consideration in reimbursement policy? Long MJ;Dreaschlin JL;Fisher J
  48. N Engl J Med v.301 Should operations be regionalized? the empirical relation between surgical volume and mortality Luft HS;Bunker JP;Entoven AC
  49. J Am Ger Soc v.134 no.8 Impact of the Medicare diagnosis-related groups on nursing homes in the Portland, Oregon, metropolitan area Lyles YM
  50. Health Care Manage Rev v.19 no.1 Hospital cost incentives in a fragmented health care system Manheim LM;Feinglass
  51. Am Economic Rev v.77 no.3 Health insurance and the demand for medical care : evidence from a randomized experiment Manning WG;Newhouse J;Duan N;Keeler E;Leibowitz A;Marquis M
  52. Health Services Research v.28 no.2 Use of medicare services before and after introduction of the prospective payment system Manton KG;Woodbury MA;Vertrees JC;Stallard E
  53. N Engl J Med v.318 no.25 DRGs - Five Years Later McCarthy CM
  54. Med Care v.36 no.8 Impact of an all-inclusive DRG payment system on inpatient utilization Menke TJ(et al.)
  55. Med care v.25 Medicare prospective payment and posthospital transfers to subacute care Morrisey MA;Sloan FA;Valvona J
  56. Health Care Mang Rev v.19 no.1 An examination of winners and losers under Medicare PPS Nancy B
  57. Journal of Health Economics v.7 Did Medicare prospective payment system cause length of stay to fall? Newhouse JP;Byme DJ
  58. Health Care Financ Rev v.9 no.1 Policy issues related to prospective payment for pediatric hospitalization Payne SMC;Restuccia JD
  59. Health Care Financ Rev v.15 no.2 An evaluation of pediatric-modified diagnosis-related groups Payne SMC;Schwartz RM
  60. Report and recommendations to the secretary ProPAC
  61. JAMA v.264 no.15 Quality of care before and after implementation of the DRG-based prospective payment system Roger Wh;Draper D;KAhn KL;Keeler EB;Rubenstein LV;Kosecoff J;Brook RH
  62. Med Care v.28 no.2 The impact of DRG-based budgeting on inpatient psychiatric care in Veterans Administration Centers Rosenheck R;Massari L;Astrachan BM
  63. Med Care v.25 Short-term responses of hospitals to the DRG prospective pricing mechanism in New Jersey Rosko MD;Broyles RW
  64. JAMA v.264 Changes in quality of care for five disease measured by implicit review, 1981 to 1986 Rubeinstein LV;Kahn KL;Reinisch EJ;Sherwood MJ;Rogers WH;KAmberg C;Draper D;Brook RH
  65. N Engl J Med v.320 The effects of the prospective payment on Medicare expenditures Russell LB;Manning CL
  66. N Engl J Med v.311 Diagnosis-related groups and hospital costs Ruth A
  67. N Engl J Med v.320 Changes in the location of death after passage of Medicare's prospective payment system Sager MA;Easterling DV;Kinding DA;Anderson DW
  68. JAMA v.257 no.13 The impact of Medicare's prospective payment system on Wisconsin Nursing Homes Sager MA;Leventhal EA;Easterling DV
  69. N Engl J Med v.318 no.23 Prospective payment : some retrospective observation Schramm CJ
  70. N Engl J Med v.324 no.15 Hospital cost containment in the 1980s: Hard lessons learned and prospects for the 1990s Schwartz WB;Mendelson DN
  71. JAMA v.257 no.2 The Inevitable failure of current cost-containment strategies : why they can provide only temporay relief? Schwartz WB
  72. Med Care v.26 no.9 Medicine Prospective Payment and the use of medical technologies in hospitals Sloan FA;Morrisey MA;Valvona J
  73. N Engl J Med v.312 no.10 Institutional responses to prospective payment based on diagnosis-related groups Stern RS;Epstein AM
  74. Health Care Manage Rev v.20 no.2 The potential impact of diagnosis related group medical management on hospital utilization and profitability Summer AT;Moreland CC
  75. Health Policy v.28 Explanining cost variation in DRGs 'acute myocardial infarction' by severity of illness Voss GB;Hasman A;Rutten F;Zwaan C;Carpay JJ
  76. Med Care v.26 no.1 Prospective Reimbursement and Diabetes Mellitus:impact on glycemic control and utilization of health service Weinberger M;Ault KA;Vinicor F(et al.)
  77. The Milbank Quarterly v.65 no.4 Economic incentives and organizational realities : managing hospitals under DRGs Weiner SL;MAxwell JH;Sapolsky HM;Dunn DL;Hsiao WC
  78. N Engl J Med v.311 Will payment based on diagnosis-related groups control hospital costs? Wennberg JE;McPherson K;Caper P
  79. Milbank Quart v.65 no.4 Economic incentives and organizational realities: managing hospitals under DRGs Winner SL(et al.)
  80. Am J Pub Health v.80 no.7 The impact of DRG on community-based service providers: Implications for the elderly Wood JB;Estes CL