요양병원 의료제공 행태에 따른 환자 진료결과 분석 : 입원환자 위탁진료건을 중심으로

Abstract

Purpose From 2008, Long-Term Care Hospitals(LTCHs) have instituted the Per Diem Payment System and specifies ‘the people who need the act of taking care’ as a subject of hospitalization by medical law. Recently, according to the rapid increase of the aging population, it contributes that lots of LTCHs have been established due to high demand in the long-term medical care system. However, there are various problems such as ambiguous pay standard and inappropriate medical treatment. Therefore, this study considers the effect of commissioned medical treatment to patients in the Long-Term Care Hospitals(LTCHs) on medical treatment outcome and it also suggests the necessity for arranging a related regulation and improving the medical care system. Subject This study used the data from bills of particular about the medical care expenses based on the integrated healthcare DW system of the health insurance service & assessment service from January to December of 2015. As its target, this study selected the 1,217 hospitals which have a result from its trade-off study among the medical care hospitals which have the bill data from January to December of 2015. After then, we included participants who have not medical history for the hospitalization during two years and it also included the 148,531 inpatients in first time at the 1,217 hospitals from January to December of 2015. Result The adjusted odds ratios(aOR) for hospital inpatient mortality of commissioned medical treatment to clinic (3rd tertile: aOR: 1.32, 95% CI: 1.06-1.66) and hospital or above (aOR: 1.26, 95% CI: 1.03-1.52) were higher than non-commissioned medical treatment group. The aORs for 30 days readmission of commissioned medical treatment to clinic (1st tertile: aOR: 1.22, 95% CI: 1.17-1.27, 2nd tertile: aOR: 1.16, 95% CI: 1.11-1.22, 3rd tertile: aOR: 1.13, 95% CI: 1.08-1.19) and hospital or above (aOR: 1.06, 95% CI: 1.01-1.10) were higher than non-commissioned medical treatment group. For duration of hospital admission, RR of commissioned medical treatment to clinic (2nd tertile: aOR: 1.02, 95% CI: 1.02-1.02, 3rd tertile: aOR: 1.01, 95% CI: 1.01-1.01) was higher than non-commissioned medical treatment. However, commissioned medical treatment to 1st tertile of clinic (aOR: 0.95, 95% CI: 0.95-0.95) and hospital (aOR: 0.98, 95% CI: 0.98-0.98) had lower aOR than non-commissioned medical treatment. Conclusion The commissioned medical treatment for the patients of the LTCHs does not have a positive effect on the patient’s medical outcome, moreover, there are difficulties for the patients with serious case and who have a high medical care demand in a current Per Diem Payment System in the LTCHs. Therefore, it could imply a negative effect on a patient’s medical outcome. In the case of the commissioned medical treatment for the patients in the LTCHs, it could happen due to lack of healthcare provider and its resource. Assuming that a related hospital can charge the medical care expenses in case of the commission medical treatment, it is included in the Per Diem Payment System. Thus, it can be an extra financial earning although the commission medical treatment is not necessary for the patients. In a reverse situation, this study suggests an investigation for the system in case of the commission medical treatment not guaranteed by the Per Diem Payment System. As a result, this study suggests new research associated with a validity of medical prescription and medical care expenses in case of the commission medical treatment, furthermore, this study suggests further research related with its actual condition and characteristics to reflect a policy for service charge improvement and its support.