한국병원경영학회지 (Korea Journal of Hospital Management)

한국병원경영학회 (Korean Society of Hospital Management)
권호 표지

포괄수가제 당연적용 후 의약품 사용현황 분석

Analysis of Drug Utilization after the Mandatory Application of the DRG Payment System in Korea

  • 강희정 (건강보험심사평가원) ;
  • 김지만 (건강보험심사평가원) ;
  • 임재영 (고려대학교 식품자원경제학과) ;
  • 이상규 (연세대학교 보건대학원) ;
  • 신의철 (가톨릭대학교 보건대학원)
  • Kang, Hee-Jeong (Health Insurance Review and Assessment Service) ;
  • Kim, Ji Man (Health Insurance Review and Assessment Service) ;
  • Lim, Jae-Young (Department of Food and Resource Economics, Korea University) ;
  • Lee, Sang Gyu (Graduate School of Public Health, Yonsei University) ;
  • Shin, Euichul (Graduate School of Public Health, The Catholic University)
  • 투고 : 2018.02.19
  • 심사 : 2018.06.12
  • 발행 : 2018.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purposes: This study aims to investigate the policy effect of mandatory application of DRG for 7 disease groups in general and tertiary hospitals. Methodology: As DRG was fully implemented in July 2013, this study compares two periods before and after the change(from July 2012 to June 2013, and from July 2013 to June 2014). The benefit claim data of the National Health Insurance Service was used for the comparison. Target patients were those who visited general or tertiary hospitals between July 2012 to June 2014. For pharmaceutical consumption, Interrupted Time Series (ITS) analysis was used to see the effect of DRG mandatory application. Findings: The number of drugs prescribed per patient and pharmaceutical expenditure both showed significant reduction compared to before the DRG implementation. Practical Implications: This study used 2 sets of 1 year period data from before and after the full implementation of DRG to analyze pharmaceutical consumption. When the comparison data accumulates further, it would be possible to conduct more diverse analysis to assess policy effect and to provide way forward for the future.

키워드

참고문헌

  1. Health Insurance Review and Assessment Service. The path of the expansion of DRG. 2013.
  2. Jung H, Baek S, Kim S. The management plans for DRG. National Health Insurance Servics. 2012.
  3. Shin S, Kang G, Kim S. Simulation on the change of practice pattern after the introduction of 7 Diagnosis-Related Groups prospective payment system in a university hospital. Korean J Health Policy Adm 2013;23(2):103-111. https://doi.org/10.4332/KJHPA.2013.23.2.103
  4. Health Insurance Review and Assessment. Effect of mandatory DRG payment system and improvement measurements. Wonju, Korea: Health Insurance Review and Assessment, 2015.
  5. Choi J. Perspectives on cost constainment and quality of health care in DRG payment system of Korea. J Korean Med Assoc 2012;55(8):706-709. https://doi.org/10.5124/jkma.2012.55.8.706
  6. Shin S, Kang G, Kim S. Simulation on the change of practice pattern after the introduction of 7 Dignosis-Related Groups prospective payment system in a university hospital. Korean J Health Policy Adm 2013;23(2):103-111. https://doi.org/10.4332/KJHPA.2013.23.2.103
  7. Lee K, Kang H, Nam C, Cho W, Kang H. Variations in hospital length of stay for diagnosis-related groups among health care institutions. Korean J Health Policy Adm 2006;16(2):77-95. https://doi.org/10.4332/KJHPA.2006.16.2.077
  8. Choi S, Kwon S, Kang G, Moon S, Lee J. Variation in hospital length of stay according to the DRG-based prospective payment system in the voluntarily participating providers. Korean J Health Policy Adm 2010;20(2):17-39. https://doi.org/10.4332/KJHPA.2010.20.2.0167
  9. Kang K, Lee J, Kim Y, Ahn T, Jeung H, Moon S, et al. A study on the development strategy of DRG. Seoul Natonal University. 2009.
  10. Lee M, Lee Y, Koh K. The change of medical care pattern and cost of cataract surgery by the DRG payment system in a general hospital. Korea J Hosp Manag 2005;10(1):48-70.
  11. Long M Chesney J, Ament R, DesHarnais S, Fleming S, Kobrinski E, et al. The effect of PPS on hospital product and productivity. Med Care 1987; 25:528-538. https://doi.org/10.1097/00005650-198706000-00007
  12. Fitzgerald J, Tierney W, Dittus R. Changing patterns of hip fracture care before and after implementation of the prospective payment system. JAMA 1987; 258:218-221. https://doi.org/10.1001/jama.1987.03400020060031
  13. Sloan F, Valvona J. Effects of the Medicare prospective payment system on hospital cost containment: an early appraisal. Milbank Q 1988; 66:191-220. https://doi.org/10.2307/3350030
  14. Barriere S. Cost-containment of antimicrobial therapy. Drug Intell Clin Pharm 1985;19(4):278-281. https://doi.org/10.1177/106002808501900405
  15. Health Insurance Review and Assessment. 7 Diagnosis-related Groups Prospective Payment System. 2012. 6
  16. Choi B, Kwon S. The system of payment for medical bills-DRG and global budgeting system. Proceedings of the the Korean Association of Health Economics and Policy; 1998 Nov.
  17. Lee S, Choi K, Jo H, Chae Y, Han E. A critical review of the application experiences of the DRG reimbursement system in the USA. Korean J Health Policy Adm 2000;10(4):20-56.
  18. 보건복지부 보험급여과. 최대한 쉽게 정리해 본 포괄수가제. 2012.
  19. Kim S, Kim H, Back M, Lee S. The effect of public report on antibiotics prescribing rate. Kor J Clin Pharm. 2010;20(3):242-247.
  20. Health Insurance Review and Assessment. DRGs in the media, January to June 2012.
  21. Shin S, Kim J. A study of simulations on the changes of physician's practice patterns in university hospitals after the Introduction of DRG in obstetrics and gynecology. J Digit Converg 2013;11(6):289-298. https://doi.org/10.14400/JDPM.2013.11.11.289
  22. Ha B, Kang G, Kim C, Kim Y. Impacts of DRG payment system on behavior of medical insurance claimants. Korean J Prev Med 2000;33(4):393-401.
  23. National Health Insurance Service. Expanding plan of 7 Diagnosis-Related Groups. 2012. 10
  24. Health Insurance Review and Assessment. Evaluation and Improvements of mandatory DRG payment system. 2015. 4.