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Early results of pediatric appendicitis after adoption of diagnosis-related group-based payment system in South Korea.

Moon SB - J Multidiscip Healthc (2015)

Bottom Line: Mean hospital stay was shortened, but the complication and readmission rates did not worsen in the DRG.Overall health care expenditure and self-payment decreased from Korean Won (KRW) 2,499,935 and KRW 985,540, respectively, in the FFS group to KRW 2,386,552 and KRW 492,920, respectively, in the DRG.For patients in the DRG, calculation by the DRG system yielded greater overall expenditure (KRW 2,020,209 vs KRW 2,386,552) but lower self-payment (KRW 577,803 vs KRW 492,920) than calculation by the FFS system.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kangwon National University Hospital, Kangwon National School of Medicine, Kangwon National University, Chuncheon, South Korea.

ABSTRACT

Purpose: As an alternative to the existing fee-for-service (FFS) system, a diagnosis-related group (DRG)-based payment system has been suggested. The aim of this study was to investigate the early results of pediatric appendicitis treatment under the DRG system, focusing on health care expenditure and quality of health care services.

Patients and methods: The medical records of 60 patients, 30 patients before (FFS group), and 30 patients after adoption of the DRG system (DRG), were reviewed retrospectively.

Results: Mean hospital stay was shortened, but the complication and readmission rates did not worsen in the DRG. Overall health care expenditure and self-payment decreased from Korean Won (KRW) 2,499,935 and KRW 985,540, respectively, in the FFS group to KRW 2,386,552 and KRW 492,920, respectively, in the DRG. The insurer's payment increased from KRW 1,514,395 in the FFS group to KRW 1,893,632 in the DRG. For patients in the DRG, calculation by the DRG system yielded greater overall expenditure (KRW 2,020,209 vs KRW 2,386,552) but lower self-payment (KRW 577,803 vs KRW 492,920) than calculation by the FFS system.

Conclusion: The DRG system worked well in pediatric patients with acute appendicitis in terms of cost-effectiveness over the short term. The gradual burden on the national health insurance fund should be taken into consideration.

No MeSH data available.


Related in: MedlinePlus

Health care expenditures stratified by the DRG code.Note: One patient in the FFS group consumed an excessive cost of KRW 5,094,818 due to postoperative complication. Values are given in KRW.Abbreviations: DRG, diagnosis-related group; FFS, fee-for-service; KRW, Korean Won.
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f2-jmdh-8-503: Health care expenditures stratified by the DRG code.Note: One patient in the FFS group consumed an excessive cost of KRW 5,094,818 due to postoperative complication. Values are given in KRW.Abbreviations: DRG, diagnosis-related group; FFS, fee-for-service; KRW, Korean Won.

Mentions: After calculating the mean expenditure according to the payment system to which each patient belonged, overall expenditures and self-payment decreased from Korean Won (KRW) 2,499,935 and KRW 985,540, respectively, before adoption of the DRG system (HE-FFSFFS) to KRW 2,386,552 and KRW 492,920, respectively, after adoption of the DRG system (HE-DRGDRG), while the insurer’s payment increased from KRW 1,514,395 before adoption of the DRG system to KRW 1,893,632 after adoption of the DRG system (Figure 1). For the most frequent DRG code (G08400), HE slightly decreased in the DRG, whereas HE increased in the DRG with G08300 (Figure 2). One patient in the FFS group developed an abscess postoperatively and required percutaneous drainage with a longer hospital stay, consuming an excessive cost of KRW 5,094,818 (Figure 2). For patients in the DRG, HE-DRGDRG yielded a greater total expenditure (KRW 2,020,209 vs KRW 2,386,552) but smaller self-payment (KRW 577,803 vs KRW 492,920) than HE-DRGFFS (Figure 3). When the costs of both groups were calculated using the same FFS system, HE-FFSFFS was greater than HE-DRGFFS (KRW 2,499,935 vs KRW 2,020,209).


Early results of pediatric appendicitis after adoption of diagnosis-related group-based payment system in South Korea.

Moon SB - J Multidiscip Healthc (2015)

Health care expenditures stratified by the DRG code.Note: One patient in the FFS group consumed an excessive cost of KRW 5,094,818 due to postoperative complication. Values are given in KRW.Abbreviations: DRG, diagnosis-related group; FFS, fee-for-service; KRW, Korean Won.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664545&req=5

f2-jmdh-8-503: Health care expenditures stratified by the DRG code.Note: One patient in the FFS group consumed an excessive cost of KRW 5,094,818 due to postoperative complication. Values are given in KRW.Abbreviations: DRG, diagnosis-related group; FFS, fee-for-service; KRW, Korean Won.
Mentions: After calculating the mean expenditure according to the payment system to which each patient belonged, overall expenditures and self-payment decreased from Korean Won (KRW) 2,499,935 and KRW 985,540, respectively, before adoption of the DRG system (HE-FFSFFS) to KRW 2,386,552 and KRW 492,920, respectively, after adoption of the DRG system (HE-DRGDRG), while the insurer’s payment increased from KRW 1,514,395 before adoption of the DRG system to KRW 1,893,632 after adoption of the DRG system (Figure 1). For the most frequent DRG code (G08400), HE slightly decreased in the DRG, whereas HE increased in the DRG with G08300 (Figure 2). One patient in the FFS group developed an abscess postoperatively and required percutaneous drainage with a longer hospital stay, consuming an excessive cost of KRW 5,094,818 (Figure 2). For patients in the DRG, HE-DRGDRG yielded a greater total expenditure (KRW 2,020,209 vs KRW 2,386,552) but smaller self-payment (KRW 577,803 vs KRW 492,920) than HE-DRGFFS (Figure 3). When the costs of both groups were calculated using the same FFS system, HE-FFSFFS was greater than HE-DRGFFS (KRW 2,499,935 vs KRW 2,020,209).

Bottom Line: Mean hospital stay was shortened, but the complication and readmission rates did not worsen in the DRG.Overall health care expenditure and self-payment decreased from Korean Won (KRW) 2,499,935 and KRW 985,540, respectively, in the FFS group to KRW 2,386,552 and KRW 492,920, respectively, in the DRG.For patients in the DRG, calculation by the DRG system yielded greater overall expenditure (KRW 2,020,209 vs KRW 2,386,552) but lower self-payment (KRW 577,803 vs KRW 492,920) than calculation by the FFS system.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kangwon National University Hospital, Kangwon National School of Medicine, Kangwon National University, Chuncheon, South Korea.

ABSTRACT

Purpose: As an alternative to the existing fee-for-service (FFS) system, a diagnosis-related group (DRG)-based payment system has been suggested. The aim of this study was to investigate the early results of pediatric appendicitis treatment under the DRG system, focusing on health care expenditure and quality of health care services.

Patients and methods: The medical records of 60 patients, 30 patients before (FFS group), and 30 patients after adoption of the DRG system (DRG), were reviewed retrospectively.

Results: Mean hospital stay was shortened, but the complication and readmission rates did not worsen in the DRG. Overall health care expenditure and self-payment decreased from Korean Won (KRW) 2,499,935 and KRW 985,540, respectively, in the FFS group to KRW 2,386,552 and KRW 492,920, respectively, in the DRG. The insurer's payment increased from KRW 1,514,395 in the FFS group to KRW 1,893,632 in the DRG. For patients in the DRG, calculation by the DRG system yielded greater overall expenditure (KRW 2,020,209 vs KRW 2,386,552) but lower self-payment (KRW 577,803 vs KRW 492,920) than calculation by the FFS system.

Conclusion: The DRG system worked well in pediatric patients with acute appendicitis in terms of cost-effectiveness over the short term. The gradual burden on the national health insurance fund should be taken into consideration.

No MeSH data available.


Related in: MedlinePlus