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Impact of payment system change from per-case to per-diem on high severity patient's length of stay

 Sung-In Jang  ;  Chung Mo Nam  ;  Sang Gyu Lee  ;  Tae Hyun Kim  ;  Sohee Park  ;  Eun-Cheol Park 
 MEDICINE, Vol.95(37) : 4839, 2016 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Case-Control Studies ; Child ; Diagnosis-Related Groups/economics* ; Female ; Humans ; Length of Stay/economics* ; Male ; Middle Aged ; Republic of Korea ; Young Adult
bundled payment ; diagnosis-related group ; DRG ; KDPC ; Korean diagnosis procedure combination
A new payment system, the diagnosis-related group (DRG) system, and Korean diagnosis procedure combination (KDPC, per-diem) payment system were officially introduced in 2002 and in 2012, respectively. We evaluated the impact of payment system change from per-case to per-diem on high severity patient's length of stay (LOS).Claim data was used. A total of 36,240 case admissions and 72,480 control admissions were included in the analysis. Segmented regression analysis of interrupted time series between cases and controls was conducted. Hospitals that consistently participated in the DRG payment system and changed to the KDPC payment system were defined as case hospitals. Hospitals that consistently participated in the DRG payment system were defined as control hospitals.LOS increased by 0.025 days per month (P?=?0.0055) for 3 surgical diagnosis-related admissions due to the bundled payment system change. LOS among emergency admissions also increased and showed an increasing tendency under the KDPC. The LOS increase was observed specifically for complex procedure admissions and high severity cases (CCI 0, 1: 0.022, P?=?0.0142; CCI 2, 3: 0.026, P?=?0.0288; CCI?≥?4: 0.055, P?=?0.0003).Although both payment systems are optimized to decrease LOS, incentives to reduce LOS are stronger under the DRG system than under the KDPC system. It is worth noting that too strong incentive for reducing LOS is suitable to high severity cases.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hyun(김태현) ORCID logo https://orcid.org/0000-0003-1053-8958
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Park, So Hee(박소희) ORCID logo https://orcid.org/0000-0001-8513-5163
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Lee, Sang Gyu(이상규) ORCID logo https://orcid.org/0000-0003-4847-2421
Jang, Sung In(장성인) ORCID logo https://orcid.org/0000-0002-0760-2878
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