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An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: Specialty versus small general hospitals

Authors
 김태현 ; 박은철 ; 장성인 
Citation
 Health Policy, Vol.113(1-2) : 93~99, 2013 
Journal Title
 Health Policy 
ISSN
 0168-8510 
Issue Date
2013
Abstract
In 2011, the Korean government designated hospitals with certain structural characteristics as specialty hospitals. This study compared the inpatient charges and length of stay of patients with joint diseases treated at these specialty hospitals with those of patients treated at small general hospitals. In addition, the study investigated whether the designation of certain hospitals as specialty hospitals had an effect on inpatient charges and length of stay. Multi-level models were used to perform regression analyses on inpatient claims data (N = 268,809) for 2010–2012 because of the hierarchical structure of the data. The inpatient charge at specialty hospitals was 19% greater than that at small general hospitals, but the length of stay was 21% shorter. After adjusting for patient and hospital level confounders, specialty hospitals had a higher inpatient charge (34.6%) and a reduced length of stay (31.7%). However, the effect of specialty hospital designation on inpatient charge (2.7% higher) and length of stay (2.3% longer) was relatively smaller. Among the patient characteristics, female gender, age, and severity of illness were positively associated with inpatient charge and length of stay. In terms of location, hospitals in metropolitan area had higher inpatient charges (5.5%), but much shorter length of stay (−14%). Several structural factors, such as occupancy rate, bed size, number of outpatients and nurses were positively associated with both inpatient charges and length of stay. However, number of specialists was positively associated with inpatient charges, but negatively associated with length of stay. In sum, this study found that specialty hospitals treating joint diseases tend to incur higher charges but produce shorter length of stay, compared to their counterparts. Specialty hospitals’ overcharging behaviors, although shorter length of stay, suggest that policy makers could introduce bundled payments for the joint procedures. To promote a successful specialty hospital system, a broader discussion and investigation that includes quality measures as well as real cost of care should be initiated.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/88511
DOI
10.1016/j.healthpol.2013.09.013
Appears in Collections:
1. 연구논문 > 4. Graduate School of Public Health > Graduate School of Public Health
1. 연구논문 > 1. College of Medicine > Dept. of Preventive Medicine
Yonsei Authors
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Link
 http://www.sciencedirect.com/science/article/pii/S0168851013002480
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