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Research Support, Non-U.S. Gov't
Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea.
Jung Kook Song, Chang yup Kim
J Prev Med Public Health. 2010;43(2):117-124.
DOI: https://doi.org/10.3961/jpmph.2010.43.2.117
  • 5,364 View
  • 65 Download
  • 4 Crossref
AbstractAbstract PDF
OBJECTIVES
The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.
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Citations

Citations to this article as recorded by  
  • Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study
    Tae Ik Chang, Haeyong Park, Dong Wook Kim, Eun Kyung Jeon, Connie M. Rhee, Kamyar Kalantar-Zadeh, Ea Wha Kang, Shin-Wook Kang, Seung Hyeok Han
    Scientific Reports.2020;[Epub]     CrossRef
  • 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.2016; 95(37): e4839.     CrossRef
  • The Effect of Mandatory Diagnosis-Related Groups Payment System
    Jae-Woo Choi, Sung-In Jang, Suk-Yong Jang, Seung-Ju Kim, Hye-Ki Park, Tae Hyun Kim, Eun-Cheol Park
    Health Policy and Management.2016; 26(2): 135.     CrossRef
  • Nurses' Cognition of Diagnosis Related Group (DRG) in Long-term Care Hospitals and Changes in Nursing Care after Application of DRG
    Eun Ha, Kyeha Kim
    Journal of Korean Academy of Nursing Administration.2012; 18(2): 176.     CrossRef
Original Articles
Changes in Quality of Care for Cesarean Section after Implementation of Diagnosis-Related Groups/Prospective Payment System.
Jun Yim, Young Hun Kwon, Du Ho Hong, Chang Yup Kim, Yong Ik Kim, Young Soo Shin
Korean J Prev Med. 2001;34(4):347-353.
  • 2,253 View
  • 20 Download
AbstractAbstract PDF
OBJECTIVES
To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. METHODS: Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were performed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. RESULTS: Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. CONCLUSION: This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data omission in medical records.
Summary
Impacts of DRG Payment System on Behavior of Medical Insurance Claimants.
Beom Man Ha, Gilwon Kang, Hyoung Keun Park, Chang Yup Kim, Yong Ik Kim
Korean J Prev Med. 2000;33(4):393-401.
  • 2,229 View
  • 31 Download
AbstractAbstract PDF
OBJECTIVES
To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. METHODS: In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. RESULTS: The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.9% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). CONCLUSIONS: After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.
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JPMPH : Journal of Preventive Medicine and Public Health
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