Health Policy Manag.  2021 Jun;31(2):180-187. 10.4332/KJHPA.2021.31.2.180.

Effects of Diagnosis-Related Group-Based Payment System on the Risk-Adjusted Cesarean Section Rate

• Kwak JM
• Lee KS

• KMID: 2525597
• DOI: http://doi.org/10.4332/KJHPA.2021.31.2.180

Abstract

Background
This study analyzed the effect of applying the diagnosis-related group (DRG)-based payment system, which was implemented in July 2012 for hospitals and clinics nationwide, on the cesarean section rate.
Methods
The subjects of the study were divided into new groups that participated in the payment system after July 2012 and maintenance groups that participated in the payment system before July 2012. As an analysis method, a difference-in-difference analysis, which is a quasi-experimental design, was used. The risk-adjusted cesarean section rate was used as a dependent variable.
Results
Seven risk factors (malpresentation of fetus, eclampsia, multiple pregnancies, problems in the placenta, previous Cesarean section, cephalopelvic disproportion, problems in amniotic fluid) were included in the final risk-adjustment model, and found to have a statistically significant relationship with the cesarean section rate. Results showed that the risk-adjusted cesarean section rate increased significantly in new groups after the application of the DRG-based payment system.
Conclusion
Study results provided policy implications for the reorganization of the DRG-based system should that reflects the demands of obstetricians, such as organizing a consultative body with obstetricians and establishing a reasonable fee.

Keyword

Diagnosis-related groups; Cesarean section; Difference-in-differences