일본 DPC 제도의 확대 및 한국에의 시사점

Abstract

Japan's Diagnosis Procedure Combination(DPC/PDPS) is a payment system unique to the country, and most characteristically Japanese in view of the DRG payment system throughout the world. While there is a 'bundling part' having a per diem score diagnosis by diagnosis, the 'non-bundled (free-for-service) items' are also widely accepted. The 'bundling part' assigns a high score for a brief stay of hospitalization, thus promoting shortened ALOS. Moreover, 'hospital coefficients' are prepared to compensate for any monetary loss due to the application of the DPC/PDPS and, on a long term basis, a wide range of incentives are provided to absorb and reflect various additional payments that are already applied under the current fee-for-service system. Though it is a voluntary participating system, many hospitals hope to join the program, meeting participation conditions such as submission of required data. The most outstanding achievement is its building of a database having plenty of clinical information from medical records and payment claims submitted by both DPC-applying and DPC-preparing hospitals to the Ministry. Japan's DPC system is appraised as stably operative and progressive by succeeding in inducing consensus of interested parties in policy decision-making, and securing a high rate of participation of tertiary hospitals within a short period of time. This conveys a strong message to the Korea's health insurance system that has failed to inch forward due to the medical providers' opposition in spite of having made efforts to introduce the DRG payment system for a long period of time.