Korean J Otorhinolaryngol-Head Neck Surg.  2016 Sep;59(9):661-667. 10.3342/kjorl-hns.2016.59.9.661.

The Analysis of Changes of Tonsillectomy after Diagnosis Related Group Based Payment System: Review of the Data Given by the Health Insurance Review & Assessment Service

• Lee HJ
• Yim C
• Won SJ
• Kim JP
• Park JJ
• Woo SH

• KMID: 2352352
• DOI: http://doi.org/10.3342/kjorl-hns.2016.59.9.661

Abstract

BACKGROUND AND OBJECTIVES
Diagnosis by Related Groups (DRG), a system forcibly implemented in all medical institutions from July 2013, was applied to tonsillectomy and adenoidectomy in the field of Otorhinolaryngology. We analyzed the changes in medical costs and evaluated the efficiency of the DRG system by analyzing the data collected before and after the DRG implementation.
SUBJECTS AND METHOD
We analyzed the total number of cases, total medical costs and per charge for tonsillectomy and adenoidectomy using the data from the Korean National Health Insurance from 2011 to 2014. We compared the number and cost of tonsillectomy and adenoidectomy by hospital type, region, and patient age.
RESULTS
The total number of tonsillectomy and adenoidectomy after the application of DRG systems in July 2013 in all medical institutions was reduced, but the total costs showed a tendancy to increase, resulting in an increase per charge of case. The number of tonsillectomy and adenoidectomy was decreased in general and specialized hospitals, but the costs were increased after DRG systems.
CONCLUSION
Medical costs per charge of case related to tonsillectomy and adenoidectomy was higher in the DRG system than in the 'fee for service' system. Increased medical costs, considered to be the most likely cause of patient copayments, are recognized in the DRG system. The results showed that saving effect of medical costs was not significant in the DRG system; it may appear to relieve patient burden in the short term, but the financial state of national health insurance is worsening.

Keyword

Adenoidectomy; Diagnosis by Related Groups; Medical costs; Tonsillectomy

MeSH Terms

Adenoidectomy
Diagnosis*
Diagnosis-Related Groups
Humans
Insurance, Health*
Methods
National Health Programs
Otolaryngology
Tonsillectomy*