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Original Articles
- Impacts of Implementation of Patient Referral System in terms of Medical Expenditures and Medical Utilization.
- Sang Hyuk Jung, Han Joong Kim
- Korean J Prev Med. 1995;28(1):207-224.
- 2,038 View
- 28 Download
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Abstract
PDF - A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospital could not get any insuranced benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992)from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it shower statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary card hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode, and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary card hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.
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Summary
- Impacts of the Implementation of the DRG Based Prospective Payment System on the Medicare Expenditures.
- Han Joong Kim, Chung Mo Nam
- Korean J Prev Med. 1994;27(1):107-116.
- 2,029 View
- 19 Download
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Abstract
PDF
- The united states adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses: (l) The PPS decelerated the increase in the hospital expenditure (part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the part A expenditure were greater than losses in the part B expenditure. The dependent variables are per capita hospital expenditure, per capita part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows: (l) The annual increase in the per capita part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significant (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita part B expenditure was accelerated by $l.73 (t=l.91) after the implementation of the PPS. (3) The increase in the total Medicine expenditure per capita was reduced by $4.26(t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.
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Summary
- Impact of District Medical Insurance Plan on Number of Hospital Patients: Using Box-Jenkins Time Series Analysis.
- Yong Jun Kim, Ki Hong Chun
- Korean J Prev Med. 1989;22(2):189-196.
- 1,851 View
- 23 Download
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Abstract
PDF
- In January 1988, district medical insurance plan was executed on a national scale in Korea. We conducted an evaluation of the impact of execution of district medical insurance plan on number of hospital patients: number of outpatients; and occupancy rate. This study was carried out by Box-Jenkins time series analysis. We tested the statistical significance with intervention component added to ARIMA model. Results of our time series analysis showed that district medical insurance plan had a significant effect on the number of outpatients and occupancy rate. Due to this plan the number of outpatients had increased by 925 patients every month which is equivalent to 8.3 percents of average monthly insurance outpatients in 1987, and occupancy rate had also increased by 0.12 which is equivalent to 16 percents of that in 1987.
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Summary
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