Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: A single center experience

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Authors: Sang Hyun Kwak ; Ji Hoon Kim ; Da Hee Kim ; Jung Min Kim ; Hyung Kwon Byeon ; Won Shik Kim ; Yoon Woo Koh ; Se-Heon Kim ; Eun Chang Choi

MeSH: Adenoidectomy/economics* ; Adenoidectomy/methods ; Adolescent ; Adult ; Child ; Child, Preschool ; Deductibles and Coinsurance ; Diagnosis-Related Groups* ; Emergency Service, Hospital/utilization ; Fee-for-Service Plans* ; Female ; Health Care Costs* ; Health Expenditures ; Humans ; Length of Stay/economics ; Length of Stay/statistics & numerical data ; Male ; Postoperative Complications/epidemiology ; Postoperative Period ; Reimbursement Mechanisms ; Republic of Korea ; Retrospective Studies ; Tonsillectomy/economics* ; Tonsillectomy/methods ; Young Adult

Keywords: Adenotonsillectomy ; Diagnosis-Related Groups (DRG) ; Fee-for-service (FFS) ; Payment system ; Tonsillectomy

Abstract: OBJECTIVES: To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea.

METHODS: We retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T).

RESULTS: A total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, P<0.05). There were no significant differences in length of hospital stay or postoperative complications among groups.

CONCLUSION: The Korean DRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system.