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Impact of a diagnosis-related group payment system on cesarean section in Korea.

Authors
 Seung Ju Kim  ;  Kyu-Tae Han  ;  Sun Jung Kim  ;  Eun-Cheol Park  ;  Hye Ki Park 
Citation
 HEALTH POLICY, Vol.120(6) : 596-603, 2016 
Journal Title
 HEALTH POLICY 
ISSN
 0168-8510 
Issue Date
2016
MeSH
Adult ; Cesarean Section/utilization* ; Diagnosis-Related Groups/economics* ; Female ; Health Expenditures/trends* ; Hospitals, Urban/statistics & numerical data ; Humans ; Insurance Claim Review ; Models, Statistical ; Pregnancy ; Republic of Korea
Keywords
Cesarean delivery ; Diagnosis related groups ; Payment reform
Abstract
Cesarean sections (CSs) are the most expensive method of delivery, which may affect the physician's choice of treatment when providing health services to patients. We investigated the effects of the diagnosis-related group (DRG)-based payment system on CSs in Korea. We used National Health Insurance claim data from 2011 to 2014, which included 1,289,989 delivery cases at 674 hospitals. We used a generalized estimating equation model to evaluate the association between the likelihood of cesarean delivery and the length of the DRG adoption period. A total of 477,309 (37.0%) delivery cases were performed by CSs. We found that a longer DRG adoption period was associated with a lower odds ratio of CSs (odds ratio [OR]: 0.997, 95% CI: 0.996-0.998). In addition, a longer DRG adoption period was associated with a lower odds ratio for CSs in hospitals that had voluntarily adopted the DRG system. Similar results were also observed for urban hospitals, primiparas, and those under 28 years old and over 33 years old. Our results suggest that the change in the reimbursement system was associated with a low likelihood of CSs. The impact of DRG adoption on cesarean delivery can also be expected to increase with time, as our finding provides evidence that the reimbursement system is associated with the health provider's decision to provide health services for patients.
Full Text
http://www.sciencedirect.com/science/article/pii/S0168851016301117
DOI
10.1016/j.healthpol.2016.04.018
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/147004
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