일 종합병원 산부인과의 포괄수가제 적용 전, 후 재원일수와 진료비의 변화

Abstract

Purpose: The Diagnosis Related Group Payment System(DRG) was naturally applied to all medical institutes from July of 2013 in order to overcome problems in the fee for service system, induce reasonable management of medical institutes, and control increases in medical expenses. Therefore, this study aimed to identify appropriateness and efficiency in DRG management by analysing the hospital length of stay and changes in fees before and after the application of DRG and present basic data for settlement, revision, and supplementation of the new system. Methods: 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 system. They received surgery in the Obstetrics and Gynecology Department of a general hospital in G metropolitan city between January and December 2013. The general characteristics of the subjects before and after the application of the DRG system, as well as the means and standard deviations of clinical characteristics were obtained and to identify changes in the hospital length of stay as well as in the use of antibiotics and fees, a t-test was conducted. Variables were revised and their significance was tested through a covariance analysis. Results: The mean hospital length of stay was significantly decreased after application of the DRG(p=0.013), and the change in antibiotics administration was not statistically significant. After the DRG application, total fees, insurance charges, and deductions increased significantly(p<0.001), and non-payment charges and total deductions decreased significantly(p<0.001). As for changes for each item, after the application of the DRG, medication fees decreased significantly(p<0.001). Conclusion: After the extended application of the DRG, the mean hospital length of stay and medication fees decreased, and patient's charges decreased thanks to changes in the payment system and expanded security. It is expected that standardized medical examinations and a flat-fee system would bring decreases to insurance rates although the burden to insurance financing is estimated as short term because of increased payments of medical fees and insurance charges. Therefore, for appropriateness and efficiency in DRG management, its management and the effect of its extended applications should be analysed on a long-term basis.

Key words : Diagnosis Related Group, Fee for service, Hospital length of stay, Medical fee