정신건강의학과 환자 입원의료비에 있어 한국형 진단명기준 환자군분류체계의 의미와 한계
The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients’ Hospital Charges
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Objectives This study was conducted to investigate whether the charges associated with Korean Diagnosis-Related Groups for mental health inpatients adequately reflect the degree of medical resource consumption for inpatient treatment in the psychiatric ward. Methods This study was conducted with psychiatric inpatients data for 2014 from the National Health Insurance claim database. The main diagnoses required for admission, classification of the hospitals, and main treatment services were analyzed by examining descriptive statistics. Homogeneities of the major diagnostic criteria were assessed by calculating coefficient variances. Explanation power was determined by R2 values. Results The most frequent disorders for psychiatric inpatient treatment were alcohol-use disorder, depressive episodes, bipolar affective disorder, and dementia in Alzheimer’s disease. Hospitalization and psychotherapy fees were the main medical expenses. Regardless of the homogeneity of the disease group, duration of hospital stay was the factor that most influenced medical expenses. In the psychiatric area, explanation power of Korean Diagnosis-Related Groups was 16.52% (p<0.05), which was significantly lower than that for other major diagnostic area. Conclusion Most psychiatric illnesses are chronic, and the density of services can vary depending on illness severity or associated complications. The current Korean Diagnosis-Related Groups criteria did not adequately represent the amount of in-hospital medical expenditures. A novel Korean classification system that reflects the expenditures of medical resources in psychiatric hospitals should be developed in order to provide appropriate reimbursements.
Abstract
Objectives This study was conducted to investigate whether the charges associated with Korean Diagnosis-Related Groups for mental health inpatients adequately reflect the degree of medical resource consumption for inpatient treatment in the psychiatric ward. Methods This study was conducted with psychiatric inpatients data for 2014 from the National Health Insurance claim database. The main diagnoses required for admission, classification of the hospitals, and main treatment services were analyzed by examining descriptive statistics. Homogeneities of the major diagnostic criteria were assessed by calculating coefficient variances. Explanation power was determined by R2 values. Results The most frequent disorders for psychiatric inpatient treatment were alcohol-use disorder, depressive episodes, bipolar affective disorder, and dementia in Alzheimer’s disease. Hospitalization and psychotherapy fees were the main medical expenses. Regardless of the homogeneity of the disease group, duration of hospital stay was the factor that most influenced medical expenses. In the psychiatric area, explanation power of Korean Diagnosis-Related Groups was 16.52% (p<0.05), which was significantly lower than that for other major diagnostic area. Conclusion Most psychiatric illnesses are chronic, and the density of services can vary depending on illness severity or associated complications. The current Korean Diagnosis-Related Groups criteria did not adequately represent the amount of in-hospital medical expenditures. A novel Korean classification system that reflects the expenditures of medical resources in psychiatric hospitals should be developed in order to provide appropriate reimbursements.
참고문헌 (23)
- 2014 National Health Insurance Statistical Yearbook, "Health Insurance Review & Assessment Service", Health Insurance Review & Assessment Service, ~ (2015)
- Kim JK, "Significance of improvement of compensation for payment system and diagnosis-related groups", J Legislative Stud, 37, pp.241~249 (2012)
- The improvement model for new diagnosis-related groups, "Kim Y", Health Insurance Review & Assessment Service, ~ (2015)
- Kang KW, "Health policy and management", pp.320~356 (2013), Seoul National University Press
- Health Insurance Review & Assessment Service, "KDRG version 4.0", Health Insurance Review & Assessment Service, ~ (2016)
- Health Insurance Review & Assessment Service, "Medical fee index 2015", Health Insurance Review & Assessment Service, ~ (2015)
- State variation in inpatient hospitalizations for mental health and substance abuse conditions, 2002-2008: statistical brief #117, "Stranges E", Agency for Healthcare Research and Quality, ~ (2011)
- Garfield RL, "Mental health financing in the United States: a primer" (2011), Kaiser Family Foundation
- Jun J, "Current status of mental illness comorbidity and political tasks", Issue Focus, 241, pp.1~8 (2014)
- Stensland M, "An examination of costs, charges, and payments for inpatient psychiatric treatment in community hospitals", Psychiatr Serv, 63, pp.666~671 (2012)
- Making mental health count: the social and economic costs of neglecting mental health care, "Hewlett E", OECD Publishing, ~ (2014)
- 강길원, "한국형진단명기준환자군의 개선과 평가", 보건행정학회지, 14(1), pp.121~147 (2004), 한국보건행정학회
- The evolution of casemix measurement using diagnosis related groups (DRGs), "Averill RF", 3M HIS Research, 5~98 (1998)
- 이대희, "건강보혐과 의료급여 환자간의 정신요법 진료량 차이 비교 - 정신병원 입원환자를 대상으로 -", 예방의학회지, 36(1), pp.4~38 (2003), 대한예방의학회
- "Mental health and addictions data and information guide" (2014)[URL]
- "2013 report of oversea business trip for patient classification system"[URL]
- National Health Service, "Mental health clustering booklet", National Health Service, ~ (2016)
- 서수경, "우리나라 정신질환자의 의료이용 현황과 장기입원 관련 요인", 예방의학회지, 42(6), pp.416~423 (2009), 대한예방의학회
- 차선경, "정신분열병 환자의 재원일수 결정요인 : 퇴원손상심층조사 자료를 이용하여", 디지털융복합연구, 11(4), pp.351~359 (2013), 한국디지털정책학회
- 최현식, "응급실 경유 정신 및 행동장애 입원환자들의 총진료비 비교 : 주상병과 부상병 환자 중심으로", 한국콘텐츠학회 논문지, 14(10), pp.562~569 (2014), 한국콘텐츠학회[DOI]
- 장옥진, "만성조현병 환자의 장기입원 요인에 대한 연구", 신경정신의학, 54(1), pp.76~83 (2015), 대한신경정신의학회[DOI]