Yonsei Med J.  2018 Jun;59(4):539-545. 10.3349/ymj.2018.59.4.539.

The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals

• Jung YW
• Pak H
• Lee I
• Kim EH

• KMID: 2410909
• DOI: http://doi.org/10.3349/ymj.2018.59.4.539

Abstract

PURPOSE
To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care.
MATERIALS AND METHODS
Using the 2012-2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs.
RESULTS
DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p < 0.001). Readmission rates decreased after introduction of DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, all p < 0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, during hysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs did not change. The number of emergency operations for hysterectomies and adnexectomies decreased.
CONCLUSION
Implementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiring expensive operative instruments and emergency operations decreased after introduction of the DRGs.

Keyword

Diagnosis-related groups; quality assurance; health care costs; prospective payment system

MeSH Terms

Cesarean Section
Diagnosis-Related Groups*
Emergencies
Female
Gynecology*
Health Care Costs
Humans
Hysterectomy
Length of Stay
National Health Programs
Obstetrics*
Outpatients
Practice Patterns, Physicians'
Pregnancy
Prospective Payment System
Tertiary Care Centers*

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