The Journal of the Korea institute of electronic communication sciences (한국전자통신학회논문지)

Korea Institute of Electronic Communication Science (한국전자통신학회)
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Changes in the Hosptal Length of Stay and Medical Cost between before and after the Applications of the DRG payment system using Health Insurance Big Data

건강보험 빅 데이터를 활용한 종합병원에서의 포괄수가제 적용 전·후 재원일수와 진료비의 변화

  • 정수진 (광주기독병원, 조선대학교 보건대학원 보건학과) ;
  • 최성우 (조선대학교 의과대학 예방의학교실)
  • Received : 2016.12.29
  • Accepted : 2017.04.24
  • Published : 2017.04.30
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Abstract

This study aimed to identify appropriateness and efficiency in the DRG payment system by analysing the hospital length of stay and changes in fees before and after the application of DRG payment system. The subjects of the study were a total of 398 patients consisting of 204 for the fee for service system and 194 for the DRG payment system. They received surgery in the Obstetrics and Gynecology (OBGY) department of a general hospital in G metropolitan city between January and December 2013. The mean hospital length of stay was significantly decreased after application of the DRG payment system(p=0.013). Total fees, insurance charges, and deductions increased significantly(p<0.001), and non-payment charges and total deductions decreased significantly(p<0.001). Application of the DRG payment system reduced length of stay, non-payment charges and total patient's cost sharing and increased out-of-pocket, insurance charges, and total fees.

본 연구는 일 종합병원 산부인과 환자를 대상으로 2013년 7월 1일 포괄수가제가 확대시행 전 후의 재원일수와 진료비를 비교 분석하여 포괄수가제 시행의 효과를 파악하고자 수행되었다. G광역시 소재 일 종합병원에서 2013년 1년간 산부인과 포괄수가제 질병군의 수술(자궁 및 자궁부속기 수술, 제왕절개술)을 받고 퇴원한 환자로, 행위별 수가제 적용 대상자는 2013년 1월~6월까지 입원한 환자 204명이었고, 포괄수가제 적용 대상자는 2013년 7월~12월까지 입원한 환자 194명으로 총 398명의 재원일수 및 진료비를 공분산분석(ANCOVA)하였다. 본 연구결과 재원일수는 행위별수가제에서 6.65(0.13)일, 포괄수가제에서 6.40(0.12)일로 감소하였고(p=0.013), 급여총진료비는 행위별수가제에서 1,726,333(46,331)원, 포괄수가제에서 2,271,115(37,069)으로 증가하였고(p<0.001), 보험자부담금은 행위별수가제에서 1,387,142(41,938)원, 포괄수가제에서 1,800,914(28,300)원으로 증가였다(p<0.001). 급여본인부담금은 행위별수가제에서 339,190(8,404)원, 포괄수가제에서 70,201(9,255)원으로 감소하였고(p<0.001), 비급여비용은 행위별수가제에서 642,243(22,039)원, 포괄수가제에서 197,507(9,091)원으로 감소하였고(p<0.001), 환자 총본인부담금도 행위별수가제에서 981,433(25,947)원, 포괄수가제에서 667,708(13,286)원으로 감소하였다(p<0.001). 본 연구결과 산부인과 환자에 대한 포괄수가제 적용은 재원일수, 비급여비용, 총본인부담금을 감소시켰고, 급여본인부담금, 보험자부담금, 급여총진료비를 증가시키는 효과를 보였다.

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