Under this study, an analysis was made on the length of stay and treatment expenses following the implementation of a pilot project, Korean Diagnosis Related Group(KDRG), in a way of forecasting the respective share for treatment expenses of patient, insurer, and supplier upon introducing the system...
Under this study, an analysis was made on the length of stay and treatment expenses following the implementation of a pilot project, Korean Diagnosis Related Group(KDRG), in a way of forecasting the respective share for treatment expenses of patient, insurer, and supplier upon introducing the system in full-scale and provide the data required in operation and system settlement of the KDRG in the days to come. This study has analyzed a total of 521 cases, excluding 122 cases of disease group and 27 cases of the patients with minor symptoms of the lowest severity for ‘Complication and Comorbidity Level 0' from the total of 670 cases of disease group as applicable to 10 cases of frequent disease from 2,039 patients(based on the discharge date) who were discharged from a general hospital located in Kyungsangpook-do during the period of July 1, 2012 ∼ December 31, 2012. The average number of length of stay for entire diseases subject for survey was 8.31 days and the average number of length of stay for each disease has H25 disease as the shortest with 2.06 days and J44 disease as the longest with 15.56 days. M48 disease was 7.13 days followed by M51 disease for 9.00 days, A09 disease for 8.25 days, B02 disease for 9.02 days, E11 disease for 12.36 days, T00 disease for 11.65 days, L03 disease for 13.04 days, and J15 disease for 14.58 days. From the treatment expenses for each medical service category provided, examination charge was 15,400 won for 2.5%, examination charge was 102,803 won for 16.7% image diagnosis and radiation treatment charge was 64,367 won for 10.4%, drug and prescription charge was 59,534 won for 9.7%, injection charge was 197,697 won for 32.1%, and treatment and surgery charge was 176,872 won for 28.7%. The composition of the total treatment expenses following the implementation of KDRG has the treatment expenses per disease on entire subject for 1,124,971 won with the comprehensive treatment expenses of 779,280 won for 69.3%, non-comprehensive treatment expenses of 237,727 won for 21.1%, minor care treatment expenses of 63,818 won for 5.7%, and non-wage treatment expenses of 44,146 won for 3.9%. As a result of t-test that converted the treatment expenses calculated for KDRG into the Fee for Service(FFS) for analysis, the total treatment expenses showed statistically noticeable difference in H25, M48, M51, A09, B02, E11, L03, and J44 diseases. Under the H25, E11, and J44 diseases, the KDRG patients paid more than the FFS patients, and under M48, M51, A09, B02, and L03 diseases, the KDRG patients paid less than the FFS patients. In the event of personal payment cases, M48, M51, A09, B02, T00, L03, J15, and J44 diseases showed statistically noticeable difference and the KDRG patients paid less than the FFS patients. In the event of insurer payment cases, H25, M51, B02, E11, T00, and J44 diseases showed statistically noticeable difference and for H25, E11, T00, and J44 diseases, the KDRG patients paid more than the FFS patients, and M51 and B02 diseases had the KDRG patients paid less than the FFS patients. When calculating the difference in the comparison of the treatment expenses of FFS and KDRG, from the total treatment expenses, the treatment expenses for each service was 561,429,000 won and the KDRG cost was 563,109,000 won, additional payment of approximately 0.3%. The treatment expenses for each service paid by the patient was 125,061,000 won and the KDRG cost was 84,538,000 won, approximately 32.4% less paid while the treatment expenses for each service paid by the insurer was 436,370,000 won, showing the KDRG treatment expenses of 478,573,000 won, paid approximately 9.7% more. It was lower than income increase rate of 2.0∼3.1% in the pilot project evaluation of Ilsan Hospital, but the hospital subject for survey implemented the KDRG to show the increase in the income of supplier, decrease in the personal payment by the patient, and increase in the insurer payment. Looking into the above results, there is a need for concerted effort to provide high quality medical service and appropriate cost for people, guarantee of investment and maintenance of supply basis as well as reasonable compensation for the supplier, and enable appropriate and high quality of optimal medical service socially for maintaining financial sustain-ability and social competency to pay for the insurer.
Under this study, an analysis was made on the length of stay and treatment expenses following the implementation of a pilot project, Korean Diagnosis Related Group(KDRG), in a way of forecasting the respective share for treatment expenses of patient, insurer, and supplier upon introducing the system in full-scale and provide the data required in operation and system settlement of the KDRG in the days to come. This study has analyzed a total of 521 cases, excluding 122 cases of disease group and 27 cases of the patients with minor symptoms of the lowest severity for ‘Complication and Comorbidity Level 0' from the total of 670 cases of disease group as applicable to 10 cases of frequent disease from 2,039 patients(based on the discharge date) who were discharged from a general hospital located in Kyungsangpook-do during the period of July 1, 2012 ∼ December 31, 2012. The average number of length of stay for entire diseases subject for survey was 8.31 days and the average number of length of stay for each disease has H25 disease as the shortest with 2.06 days and J44 disease as the longest with 15.56 days. M48 disease was 7.13 days followed by M51 disease for 9.00 days, A09 disease for 8.25 days, B02 disease for 9.02 days, E11 disease for 12.36 days, T00 disease for 11.65 days, L03 disease for 13.04 days, and J15 disease for 14.58 days. From the treatment expenses for each medical service category provided, examination charge was 15,400 won for 2.5%, examination charge was 102,803 won for 16.7% image diagnosis and radiation treatment charge was 64,367 won for 10.4%, drug and prescription charge was 59,534 won for 9.7%, injection charge was 197,697 won for 32.1%, and treatment and surgery charge was 176,872 won for 28.7%. The composition of the total treatment expenses following the implementation of KDRG has the treatment expenses per disease on entire subject for 1,124,971 won with the comprehensive treatment expenses of 779,280 won for 69.3%, non-comprehensive treatment expenses of 237,727 won for 21.1%, minor care treatment expenses of 63,818 won for 5.7%, and non-wage treatment expenses of 44,146 won for 3.9%. As a result of t-test that converted the treatment expenses calculated for KDRG into the Fee for Service(FFS) for analysis, the total treatment expenses showed statistically noticeable difference in H25, M48, M51, A09, B02, E11, L03, and J44 diseases. Under the H25, E11, and J44 diseases, the KDRG patients paid more than the FFS patients, and under M48, M51, A09, B02, and L03 diseases, the KDRG patients paid less than the FFS patients. In the event of personal payment cases, M48, M51, A09, B02, T00, L03, J15, and J44 diseases showed statistically noticeable difference and the KDRG patients paid less than the FFS patients. In the event of insurer payment cases, H25, M51, B02, E11, T00, and J44 diseases showed statistically noticeable difference and for H25, E11, T00, and J44 diseases, the KDRG patients paid more than the FFS patients, and M51 and B02 diseases had the KDRG patients paid less than the FFS patients. When calculating the difference in the comparison of the treatment expenses of FFS and KDRG, from the total treatment expenses, the treatment expenses for each service was 561,429,000 won and the KDRG cost was 563,109,000 won, additional payment of approximately 0.3%. The treatment expenses for each service paid by the patient was 125,061,000 won and the KDRG cost was 84,538,000 won, approximately 32.4% less paid while the treatment expenses for each service paid by the insurer was 436,370,000 won, showing the KDRG treatment expenses of 478,573,000 won, paid approximately 9.7% more. It was lower than income increase rate of 2.0∼3.1% in the pilot project evaluation of Ilsan Hospital, but the hospital subject for survey implemented the KDRG to show the increase in the income of supplier, decrease in the personal payment by the patient, and increase in the insurer payment. Looking into the above results, there is a need for concerted effort to provide high quality medical service and appropriate cost for people, guarantee of investment and maintenance of supply basis as well as reasonable compensation for the supplier, and enable appropriate and high quality of optimal medical service socially for maintaining financial sustain-ability and social competency to pay for the insurer.
주제어
#KDRG(Korean Diagnosis Related Group) Length of Stay
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