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중증도 분류에 따른 진료비 차이: 간질환을 중심으로

Other Titles
 Differences of Medical Costs by Classifications of Severity in Patients of Liver diseases 
Authors
 박은철 ; 이상규 
Citation
 보건행정학회지, Vol.23(1) : 35~43, 2013 
Journal Title
 보건행정학회지 
ISSN
 1225-4266 
Issue Date
2013
Abstract
Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/86860
DOI
10.4332/KJHPA.2013.23.1.035
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Preventive Medicine
1. 연구논문 > 4. Graduate School of Public Health > Graduate School of Public Health
Yonsei Authors
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Link
 http://dx.doi.org/10.4332/KJHPA.2013.23.1.035
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