본문 바로가기
KERD
논문KCI 등재

중소병원의 전문화 전략과 운영성과의 관계에 대한 실증연구: 포괄수가제 대상 소화기계 질환을 중심으로

Empirical Study on the Association between Specialization and Operational Performance among Small and Midsize Hospitals: Focusing on Diseases and Disorders of the Digestive System under DRG Payment

최재영|서슬기
경영연구원 (Management Research Institute)|2020.06|의료경영학연구 (Health Service Management Review)|제14권 제2호|pp. 27-36|DOI 10.18014/hsmr.2020.14.2.27

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

Length of StayMedical ExpenseHospital Specialization

초록

The aim of this study is to explore the associations between small and midsize hospital specialization and length of stay and inpatient medical charge using claims data of the Health Insurance and Review Assessment National Inpatient Sample from 2018 for anal surgery, hernia surgery, and appendectomy. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 4,970 patients discharged after anal surgery from 91 hospitals, from 378 patients discharged after hernia surgery from 73 hospitals, 856 patients discharged after appendectomy from 91 hospitals. We found that patients who were discharged after anal surgery or hernia surgery from specialized small and midsize hospitals stayed shorter and paid more inpatient charge than those who were discharged from less specialized hospitals, after controlling for patient demographic and clinical factors and hospitals’structural, operational and contextual factors. Furthermore post-hoc analysis revealed that patients discharged after complex appendectomy from more specialized hospitals stayed shorter and paid more inpatient charge than those who discharged from less specialized hospitals. We discussed managerial and health policy implications below.

Abstract

The aim of this study is to explore the associations between small and midsize hospital specialization and length of stay and inpatient medical charge using claims data of the Health Insurance and Review Assessment National Inpatient Sample from 2018 for anal surgery, hernia surgery, and appendectomy. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 4,970 patients discharged after anal surgery from 91 hospitals, from 378 patients discharged after hernia surgery from 73 hospitals, 856 patients discharged after appendectomy from 91 hospitals. We found that patients who were discharged after anal surgery or hernia surgery from specialized small and midsize hospitals stayed shorter and paid more inpatient charge than those who were discharged from less specialized hospitals, after controlling for patient demographic and clinical factors and hospitals’structural, operational and contextual factors. Furthermore post-hoc analysis revealed that patients discharged after complex appendectomy from more specialized hospitals stayed shorter and paid more inpatient charge than those who discharged from less specialized hospitals. We discussed managerial and health policy implications below.

참고문헌 (38)

  1. "건강보험심사평가원 보건의료빅데이터 개방시스템, 건강보험 진료 통계"[URL]
  2. 곽진미, "DRGs(Diagnosis Related Groups)별 환자집중도 수준에 따른 입원진료비와 재원일수의 차이 분석", 보건의료산업학회지, 8(4), pp.13~24 (2014), 보건의료산업학회
  3. 국민건강보험공단, "2018년 주요수술 통계연보", ~ (2019)
  4. 김록영, "건강보험심사평가원 환자표본자료 (HIRA-NPS)의 소개", HIRA 정책동향, 6(5), pp.37~47 (2012)
  5. 김재현, "병원 전문화가 건당 재원일수와 건당 의료비에 미치는 영향", 보건행정학회지, 26(2), pp.107~114 (2016), 한국보건행정학회
  6. 김태화, "원형 자동문합기를 이용한 치핵절제술의 임상적 경험", Annals of Surgical Treatment and Research, 66(5), pp.391~396 (2004), 대한외과학회
  7. 도명식, "신뢰성 개념을 이용한 적정 포장 수명분포 선정", 한국도로학회논문집, 12(1), pp.61~69 (2010), 한국도로학회
  8. 문경준, "입원환자의 집중도 수준에 따른 재원일수의 변이 분석 : 분만환자를 중심으로", 한국콘텐츠학회 논문지, 13(8), pp.314~323 (2013), 한국콘텐츠학회[DOI]
  9. 박흥수, "복강경 충수절제술과 개복 충수절제술의 비교 고찰-수술 및 술후 회복의 관점에서", ~ (1995)
  10. 서슬기, "병원의 전문화 수준에 따른 재원일수, 진료비 차이에 대한 연구 : 대장항문질환, 관절질환, 뇌혈관질환을 중심으로", 의료경영학연구, 13(1), pp.17~26 (2019), 경영연구원[DOI]
  11. 신상수, "보건의료분야 다수준 분석 연구의 체계적 문헌 고찰: 국내 연구동향과 비뚤림 위험 평가를 중심으로", 보건사회연구, 35(4), pp.157~189 (2015), 한국보건사회연구원[DOI]
  12. 신현희, "중소병원 육성. 지원 방안을 위한 로드맵 개발", 병원경영정책연구, 3(2), pp.57~73 (2014)
  13. 양동현, "병원경영분석" (2011), 도서출판 청람
  14. 유해원, "병원의 입원 진료 집중화 전략과 융합적 운영 성과", 한국융합학회논문지, 7(4), pp.59~66 (2016), 한국융합학회
  15. 유해원, "병원 진료의 전문화와 운영 성과 간의 관계: 재원일수와 급여비용을 중심으로", 보건의료산업학회지, 10(1), pp.1~11 (2016), 보건의료산업학회
  16. 이상일, "중소병원 의료 질 향상을 위한 평가방안 마련", ~ (2018)
  17. 이창우, "충수절제술, 수정체소절개, 제왕절개술 의료수가 수준에 대한 OECD국가 비교 연구", 대한의사협회지, 56(6), pp.523~532 (2013), 대한의사협회
  18. 함유상, "병원의 규모와 범위의 경제", 보건행정학회지, 18(1), pp.21~42 (2008), 한국보건행정학회
  19. Bockhorn, L. N., "Increased Orthopedic Specialization Lowers Costs and Improves Outcomes in Total Joint Arthroplasty", The Journal of arthroplasty, 34(7), pp.S76~S79 (2019)
  20. Chandler, A. D., "Scale and scope: The dynamics of industrial capitalism" (2009), Harvard University Press
  21. Clark, J. R., "Broadening focus: Spillovers, complementarities, and specialization in the hospital industry", Management Science, 58(4), pp.708~722 (2012)
  22. Cram, P., "Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data", Health services research, 45(1), pp.62~78 (2010)
  23. Cram, P., "Percutaneous coronary intervention outcomes in US hospitals with varying structural characteristics: Analysis of the NCDR®", American heart journal, 163(2), pp.222~229 (2012)
  24. Cram, P., "Cardiac revascularization in specialty and general hospitals", New England Journal of Medicine, 352(14), pp.1454~1462 (2005)
  25. Cram, P., "A comparison of total hip and knee replacement in specialty and general hospitals", JBJS, 89(8), pp.1675~1684 (2007)
  26. Elixhauser, A., "Comorbidity measures for use with administrative data", Medical care, pp.8~27 (1998)
  27. Glaser, D., "An introduction to multilevel modeling for anesthesiologists", Anesthesia & Analgesia, 113(4), pp.877~887 (2011)
  28. Greenwald, L., "Specialty versus community hospitals: referrals, quality, and community benefits", Health affairs, 25(1), pp.106~118 (2006)
  29. Greve, H. R., "Organizational learning from performance feedback: A behavioral perspective on innovation and change" (2003), Cambridge University Press
  30. Hagen, T. P., "Relation between hospital orthopaedic specialisation and outcomes in patients aged 65 and older: retrospective analysis of US Medicare data", Bmj, 340, pp.c165~ (2010)
  31. Hwang, C. W., "Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals", Medical care, pp.720~728 (2007)
  32. McDermott, C. M., "Focus as emphasis: Conceptual and performance implications for hospitals", Journal of Operations Management, 29(6), pp.616~626 (2011)
  33. Report to Congress: physicianowned specialty hospitals revisited, "Medicare Payment Advisory Commission", ~ (2009)
  34. Nooteboom, B., "Learning and innovation in organizations and economies" (2000), OUP Oxford
  35. Popescu, I., "Do specialty cardiac hospitals have greater adherence to acute myocardial infarction and heart failure process measures? An empirical assessment using Medicare quality measures: Quality of care in cardiac specialty hospitals", American heart journal, 156(1), pp.155~160 (2008)
  36. United States. General Accounting Office, "Specialty hospitals: Information on national market share, physician ownership, and patients served", US General Accounting Office, ~ (2003)
  37. Wruck, K. H., "Science, specific knowledge, and total quality management", Journal of Accounting and economics, 18(3), pp.247~287 (1994)
  38. Zwanziger, J., "Differentiation and specialization in the California hospital industry 1983 to 1988", Medical care, pp.361~372 (1996)

관련 논문AI추천

병원의 전문화 수준에 따른 재원일수, 진료비 차이에 대한 연구 : 대장항문질환, 관절질환, 뇌혈관질환을 중심으로서슬기, 최재영경영연구원 · 의료경영학연구2019 · 제13권 제1호병원 진료의 전문화와 운영 성과 간의 관계: 재원일수와 급여비용을 중심으로김경훈, 유해원보건의료산업학회 · 보건의료산업학회지2016 · 제10권 제1호DRGs(Diagnosis Related Groups)별 환자집중도 수준에 따른 입원진료비와 재원일수의 차이 분석곽진미, 이광수보건의료산업학회 · 보건의료산업학회지2014 · 제8권 제4호병원의 입원 진료 집중화 전략과 융합적 운영 성과유해원한국융합학회 · 한국융합학회논문지2016 · 제7권 제4호입원서비스의 집중화 수준과 진료비 간의 관계 분석: 2009년~2011년곽진미, 권혁준, 이광수한국지식경영학회 · 지식경영연구2015 · 제16권 제1호준실험적 방법을 이용한 DRG지불제도 참여효과권순만, 최숙자한국보건경제정책학회 · 보건경제와 정책연구2016 · 제22권 제3호

이 간행물의 다른 논문 (4건)

자문적 영업역량이 직무성과에 미치는 영향: 제약 및 의료기기 영업사원을 대상으로조성찬, 차재빈pp. 1-11간호관리학 실습학생의 임상실습 역량, 임상실습 적응 및 팀워크가 전문직 사회화에 미치는 영향에 관한 연구안성식, 서명선, 박인숙pp. 13-25미용성형수술을 위한 의료기관 선택요인 분석장혜정, 심재선, 조효명pp. 37-47의료서비스 이용자의 조절초점과 인공지능진료시스템 이용의도서상윤, 신은규pp. 49-57
원문 보기