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The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea.

 Seung Ju Kim  ;  Eun-Cheol Park  ;  Sun Jung Kim  ;  Kyu-Tae Han  ;  Euna Han  ;  Sung-In Jang  ;  Tae Hyun Kim 
 EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol.26(1) : 42-47, 2016 
Journal Title
Issue Date
Adult ; Diagnosis-Related Groups/statistics & numerical data* ; Economic Competition/statistics & numerical data* ; Female ; Humans ; Insurance Claim Review ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; National Health Programs/statistics & numerical data* ; Patient Readmission/statistics & numerical data ; Quality Indicators, Health Care/statistics & numerical data ; Quality of Health Care/statistics & numerical data* ; Republic of Korea
BACKGROUND: The diagnosis-related group-based prospective payment programme was introduced in Korea in 1997 as a pilot programme to control health spending. In July 2013, the programme was implemented throughout the nation. The aim of our study is to evaluate the relationship between quality of care and market competition following the introduction of the new payment system in Korea. METHODS: We conduct an observational analysis using National Health Insurance claim data from 2011 to 2014. We analyse data on readmission within 30 days, length of stay, and number of outpatient visits for 1742 hospitals and 821 912 cases. We use a generalized estimating equation model to evaluate readmission within 30 days and number of outpatient visits and a multi-level regression model to assess length of stay. RESULTS: Total readmission within 30 days is 10 727 (1.3%). High competition areas present a lower risk of readmission [odds ratio (OR): 0.95, P: 0.0277], a longer length of stay (1%, P < 0.0001), and an increased number of outpatient visits (Relative Risk: 1.11, P: 0.0011) as compared with moderate competition areas. Risk of readmission is higher in low competition areas as compared with moderate competition areas (OR: 1.21, P < 0.0001). CONCLUSION: The effects of the introduction of the new payment system differed by degree of market competition. Thus, evaluation about the effect of new payment system on hospital performance should be measured in combination with the degree of hospital market structure.
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4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hyun(김태현) ORCID logo https://orcid.org/0000-0003-1053-8958
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Jang, Sung In(장성인) ORCID logo https://orcid.org/0000-0002-0760-2878
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