The Adequacy on DRG Classification System in Obstetric Group

Kim, Young Ju; Yoo, Yoon Soon; Lee, Sun Hee; Jung, Sang Hyuk; Yu, Seung Hum

Abstract

OBJECTIVE
This study was performed to be evaluated the adequacy on DRG classification in Obstetric group and analyzed the difference for medical benefit payment from the insurance and total medical reimbursement according to complication and age in vaginal delivery group and Cesarean section group.
METHODS
This study has been analyzed for medical benefit payment from the insurance and total medical reimbursement of patients from University of hospital since Feburary 1999 to December 2000 and the data from Health Insurance Review Agency since Feburary 2001 to July 2001.
RESULTS
Since these cases were not reported even 1 case in Korea, there were 113 cases needed to be deleted in DRG classification disease group. In the evaluation of disease severity for DRG classification disease group, there were 11 cases should be added to severe complicating diagnosis, 5 cases should be removed from severe complicating diagnosis, and 6 cases should be added to moderate complicating diagnosis in vaginal delivery and Cesarean section group. Medical benefit payment from the insurance and total medical reimbursement in the group with having severe complication were significantly higher than in the group without complication in Cesarean section group. Medical benefit payment from the insurance and total medical reimbursement in the group with having severe complication in primigravida vaginal delivery group and the group with having severe complication in multigravida vaginal delivery group were significantly higher in the group without complication in primigravida vaginal delivery group and the group without complication in multigravida vaginal delivery group, separately.
CONCLUSION
Severity classification system-severe complication, multiple complication, moderate complication, non-complication-should be included in obstetric DRG classification system.