Health Policy Manag.  2020 Mar;30(1):82-91. 10.4332/KJHPA.2020.30.1.82.

Medical Service Variation of Urinary Incontinence Surgery and Uterine Polypectomy Using a Multilevel Analysis

• Kim SM
• Ahn BR
• Kim JL
• Lee HJ

• KMID: 2507288
• DOI: http://doi.org/10.4332/KJHPA.2020.30.1.82

Abstract

Background
This study investigates the influence factors of medical service variations using medical charge and the length of stay (LOS) for urinary incontinence surgery and uterine polypectomy.
Methods
The National Health Insurance claims data and Medical Resource Report by the Health Insurance Review & Assessment Service in 2016 were used. Frequency analysis, one-way analysis of variance, and Bonferroni post-hoc tests were executed for each surgery. A multilevel analysis was executed to assess the factors to the medical charge and LOS for each surgery in patient, doctor, and hospital level.
Results
Fifty-two point eight percent of urinary incontinence surgery and 87.1% of uterine polypectomy were distributed in general and tertiary hospitals. Among three levels, the patient level variation was 61.5% or 77.2% in medical charge and 93.9% or 96.3% in LOS, respectively. The doctor level variation was 29.6% or 22.6% in medical charge and 0.6% or 0.0% in LOS, respectively. The institution level variation was 8.9% or 0.2% in medical charge and 5.5% or 3.7% in LOS, respectively. Number of other disease and organizational type were main factors that affected the charge and LOS for urinary incontinence surgery and uterine polypectomy.
Conclusion
Medical service variations of the urinary incontinence surgery and uterine polypectomy were the largest for the patient level, followed by doctor level for the medical charge, and the institution level for the LOS.

Keyword

Medical service variation; Urinary incontinence surgery; Uterine polypectomy; Medical charge; Length of stay