Health Policy Manag.  2020 Jun;30(2):178-184. 10.4332/KJHPA.2020.30.2.178.

The Effect of Reform of New Diagnosis-Related Groups on Coverage of National Health Insurance

Affiliations
  • 1Institute of Health Insurance & Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 2Institute of Medical Insurance Review Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 3Institute of Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Abstract

Background
Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance.
Methods
This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695.
Results
The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356).
Conclusion
The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.

Keyword

Korean diagnosis-related groups; Insurance coverage; Healthcare reform
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