Health Policy and Management (보건행정학회지)

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

한국형진단명기준환자군의 개선과 평가

  • 강길원 (건강보험심사평가원) ;
  • 박하영 (가톨릭대학교 의료경영대학) ;
  • 신영수 (서울대학교 의과대학 의료관리학교설)
  • Published : 2004.03.01
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Abstract

Since the pilot program for a DRG-based prospective payment system was introduced in 1997, the performance of KDRGs has been one of hotly debated issues. The objectives of this study are to refine the classification algorithm of the KDRGs and to assess the improvement achieved by the refinement. The U.S. Medicare DRGs version 17.0 and the Australian Refined DRGs version 4.1 were reviewed to identify areas of possible impro-vement. Refined changes in the classification and result of date analyses were submitted to a panel of 48 physicians for their reviews and suggestions. The refinement was evaluated by the variance reduction in resource utilization achieved by the KDRG The database of 2,182,168 claims submitted to the Health Insurance Review Agency during 2002 was used for evaluation. As the result of the refinement, three new MDCs were introduced and the number of ADEGs increased from 332 to 674. Various age splits and two to four levels of severity classification for secondary diagnoses were introduced as well. A total of 1,817 groups were defined in the refined KDRGs. The variance reduction for charges of all patients increased from 48.2％ to 53.6％ by the refinement, and from 65.6％ to 73.1％ for non-outlier patients. The r-square for length of stays of all patients was increased from 28.3％ to 32.6％, and from 40.4％ to 44.9％ for non-outlier patients. These results indicated a significant improvement in the classification accuracy of the KDRG system.

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