The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals

Abstract

PurposeTo examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care.Materials and MethodsUsing the 2012–2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs.ResultsDRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p<0.001). Readmission rates decreased after introduction of DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, all p<0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, during hysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs did not change. The number of emergency operations for hysterectomies and adnexectomies decreased.ConclusionImplementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiring expensive operative instruments and emergency operations decreased after introduction of the DRGs.

The effect of diagnosis-related group payment system on the quality of medical care for pelvic organ prolapse in Korean tertiary hospitals

“…Contrary to the present study, a previous study found no adverse perioperative outcomes after the introduction of DRG for all hysterectomies for benign conditions: no increase in outpatient visits and readmission due to early discharge was noted [4]. This discrepancy may be due to the diversity of indications for hysterectomy.…”

“…Nonetheless, a prior study found that the rates of concomitant myomectomy and adnexectomy during cesarean section and colporrhaphy during hysterectomy did not change after the introduction of DRG system. However, there was a significant decrease in the rates of colpopexy and midurethral sling procedures at the time of hysterectomy [4]. The present study that only included the patients who underwent hysterectomy for POP during the extended period showed a similar result.…”

“…This discrepancy may be due to the diversity of indications for hysterectomy. Although POP is one of the major indications for hysterectomy, it corresponds to just 11–13% of all hysterectomies, while the majority of hysterectomies are performed to treat other diseases including leiomyoma, adenomyosis, abnormal uterine bleeding, and benign ovarian neoplasm [4, 10]. While hysterectomies for other benign indications are usually performed for young women, POP surgeries are most often performed for women 70 years and older [11].…”

“…Further, it has also been reported that the implementation of the DRG-based payment system in the field of obstetrics and gynecology, specifically with regard to cesarean section, hysterectomy, and adnexectomy, in Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission. Decreases in the rates of concomitant colpopexy and midurethral slings at the time of hysterectomy were also reported after introduction of the DRG [4].…”

The New Diagnosis-Related Group Reimbursement System and Laboratory Test Quality in Korea: Analysis of External Quality Assessment Results

“…The compulsory national health insurance program of Korea was originally based on an FFS system [ 7 ]. After starting a pilot program in 1997 and the voluntary period starting in 2002, Korea implemented a mandatory DRG-based payment system for seven groups of specific operations/diseases in inpatient care on 1 July 2012 [ 8 ].…”