Does Korea's current diagnosis-related group-based reimbursement system appropriately classify appendectomy patients?

Abstract

PurposeAs several years have passed since the implementation of the Korean diagnosis-related group (DRG) payment system for appendicitis, its early outcomes should be assessed to determine if further improvements are warranted.MethodsWe retrospectively analyzed clinical data from Korean patients who underwent appendectomy, dividing the sample into 2 groups of those who received services before and after implementation of the DRG system. Based on the DRG code classification, patient data were collected including the amount of DRG reimbursement and the total in-patient costs. We subsequently performed univariate and multivariate analyses to identify independent factors contributing to higher total in-patient cost.ResultsAlthough implementation of the DRG system for appendicitis significantly reduced postoperative length of stay (2.8 ± 1.0 days vs. 3.4 ± 1.9 days, P < 0.001), it did not reduce total in-hospital cost. The independent factors related to total inhospital cost included patient age of 70 years or more (odds ratio [OR], 3.214; 95% confidence interval [CI], 1.769–5.840; P < 0.001) and operation time longer than 100 minutes (OR, 3.690; 95% CI, 2.007–6.599, P < 0.001). In addition, older patients (≥70 years) showed a nearly 10 times greater relative risk for having a comorbid condition (95% CI, 5.141–20.214; P < 0.001) and a 3.255 times greater relative risk for having higher total in-hospital cost (95% CI, 1.731–6.119, P < 0.001).ConclusionIt appears that older patients (>70 years) have greater comorbidities, which contribute to higher inpatient costs. Thus, our study suggests that patient age be considered as a DRG classification variable.

Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data

“…South Korea started to introduce national health insurance in 1977 and adopted a fee-for service (FFS) system for health care services [6]. FFS refers to a payment system that healthcare provider is paid for each service conducted, and research has indicated that FFS systems result in rapid increases in medical costs [7]. The Korean government decided to introduce a DRGs payment system to solve problems stemming from overtreatment under the FFS system.…”

Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?

“…Our results showed that older age and open appendectomy were associated with prolonged hospital stay, corroborating previous study results [ 28 ]. The absolute lengths of hospital stay in our results may be longer than those in other countries [ 29 ], which may be associated with the generous reimbursement policy of Korean national medical insurance system in regard to hospitalization cost [ 30 ].…”

The Effects of Preoperative Pain Education on the Decision to Discharge Patients Following Single-Incision Laparoscopic Appendectomy

“…Introduction of diagnosis-related group (DRG) systems where hospitals cover medical cost payments for patients undergoing appendectomy has been shown to reduce significantly the economic burden for patients in relation to medical costs nationwide [ 15 ]. Despite patients with appendectomy staying longer in hospital compared to the average length of hospital stay, their costs tend not to increase due to the DRG system [ 16 ]. However, some patients decline postoperative discharge from the hospital until complete recovery, despite lack of pain and fatigue.…”

“…patients undergoing appendectomy has been shown to reduce significantly the economic burden for patients in relation to medical costs nationwide [15]. Despite patients with appendectomy staying longer in hospital compared to the average length of hospital stay, their costs tend not to increase due to the DRG system [16].…”