Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Simulation on the Change of Practice Pattern after the Introduction of 7 Diagnosis-related Groups Prospective Payment System in a University Hospital

7개 질병군 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험

  • Shin, Sam-Chul (Department of Health Information and Management, Chungbuk National University College of Medicine) ;
  • Kang, Gil-Won (Department of Health Information and Management, Chungbuk National University College of Medicine) ;
  • Kim, Sang-Won (Department of Health Information and Management, Chungbuk National University College of Medicine)
  • 신삼철 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 강길원 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 김상원 (충북대학교 의과대학 의료정보학 및 관리학교실)
  • Received : 2013.03.07
  • Accepted : 2013.04.04
  • Published : 2013.06.30
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Abstract

Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.

Keywords

References

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  1. The Effect of Mandatory Diagnosis-Related Groups Payment System vol.26, pp.2, 2016, https://doi.org/10.4332/KJHPA.2016.26.2.135
  2. Analysis of Changes in Patient Costs in 7Diagnosis-Related Groups through Time Series Analysis vol.11, pp.3, 2017, https://doi.org/10.12811/kshsm.2017.11.3.023