College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea.
Institute of Health Services Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea.
BMC Health Serv Res. 2019 Oct 30;19(1):776. doi: 10.1186/s12913-019-4650-8.
In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system.
We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology.
Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups.
Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.
2002 年，韩国引入了自愿按疾病诊断相关分组（DRGs）付费制度，该制度针对七个疾病组，从 2013 年开始要求所有医院参与。本研究的主要目的是比较由 DRGs 或按服务项目付费（FFS）支付系统管理的自愿参与医院（VPH）和强制参与医院（MPH）的患者护理结果。
我们从 2011 年 7 月至 2014 年 7 月的健康保险审查和评估中收集了 DRGs 和 FFS 住院记录（n=3,038,006），并根据支付系统、DRGs 实施时间和医院类型比较了住院时间、总医疗费用、向门诊转移服务和再入院率。我们使用广义估计方程和差异中的差异方法分析了 DRGs 支付系统强制引入对患者护理结果的影响。
值得注意的是，DRGs 支付系统强制引入后，MPH 患者的住院时间明显短于 VPH 患者，再入院率也较低。两组患者向门诊转移服务的比例相似。
我们的研究结果表明，韩国的 DRGs 支付政策降低了住院时间和再入院率。鉴于 FFS 鼓励不必要的资源使用，这些发现支持在韩国继续实施和扩大 DRGs 支付系统，用于其他疾病。如果韩国政府考虑将 DRGs 扩大到包括其他并发症发生率较高的疾病，政策制定者需要监测固定定价导致的医疗质量下降。
