Lab Med Online.  2021 Jan;11(1):47-54. 10.47429/lmo.2021.11.1.47.

Physicians’ Understanding of the New Diagnosis-Related Group (NDRG) Payment System According to NDRG Participation

• Ji M
• Choi Yj
• Kim S
• Yun YM
• Um TH
• Heo JH
• Lee KS
• Kwon GC
• Kim H

• KMID: 2525780
• DOI: http://doi.org/10.47429/lmo.2021.11.1.47

Abstract

Background
The medical insurance payment system can have a considerable effect on quality of care, medical expenses, and laboratory test utilization. The new diagnosis-related group (NDRG) is a mixed payment system implemented throughout many hospitals. To date, physicians’ level of understanding of the NDRG system has received minimal research attention. We have conducted a survey targeting doctors affiliated with various hospitals.
Methods
Forty-two NDRG participating public hospitals (participant group), and 84 non-participating hospitals (non-participant group) were included in this study. Three physicians per hospital (clinical pathologist, internist, and surgical specialist) were asked to complete a questionnaire about the influence of the NDRG system. A total of 116 doctors (32.5%) responded.
Results
Recognition of the NDRG was significantly higher among the participant group than among non-participants (87.9% vs. 45.8%, P = 0.001). About half of the respondents expected introduction of the NDRG to help reduce medical overuse and length of stay, while about 80% expected a negative impact on overall quality of care and quality control for laboratory tests, irrespective of group. In terms of patient satisfaction and inpatient laboratory test utilization, the participant group responded more positively. About half of the respondents had some knowledge of quality incentives, and about 90% agreed with the need for additional rates or application of quality incentives under the NDRG system.
Conclusions
In this study, the physicians’ degree of understanding of the NDRG system was quantitatively assessed, and some areas in need of reform were addressed.

Keyword

New diagnosis-related group payment system; Physicians’ understanding; Laboratory test utilization.

Reference

1. Jung YW, Pak H, Lee I, Kim EH. 2018; The effect of diagnosis-related group payment system on quality of care in the field of obstetrics and gynecology among Korean tertiary hospitals. Yonsei Med J. 59:539–45. DOI: 10.3349/ymj.2018.59.4.539. PMID: 29749137. PMCID: PMC5949296.

2. Choi JW, Kim SJ, Park HK, Jang SI, Kim TH, Park EC. 2019; Effects of a mandatory DRG payment system in South Korea: analysis of multi-year nationwide hospital claims data. BMC Health Serv Res. 19:776. DOI: 10.1186/s12913-019-4650-8. PMID: 31666066. PMCID: PMC6822472.

3. Kwon S. 2003; Payment system reform for health care providers in Korea. Health Policy Plan. 18:84–92. DOI: 10.1093/heapol/18.1.84. PMID: 12582111.

4. Jeon MJ, Choo SP, Kwak YH, Kim DW, Kim EH. 2019; The effect of diagnosis-related group payment system on the quality of medical care for pelvic organ prolapse in Korean tertiary hospitals. PLoS One. 14:e0220895. DOI: 10.1371/journal.pone.0220895. PMID: 31430319. PMCID: PMC6701833.

5. Kim JW, Shin DW, Chae JJ, Kim JY, Park SG. 2015; Impact of the new payment system on laparoscopic appendectomy in Korea. J Surg Res. 199:338–44. DOI: 10.1016/j.jss.2015.04.070. PMID: 26025628.

6. Kwak SH, Kim JH, Kim DH, Kim JM, Byeon HK, Kim WS, et al. 2018; Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: a single center experience. Auris Nasus Larynx. 45:504–7. DOI: 10.1016/j.anl.2017.07.005. PMID: 28756097.

7. Kim YK. 2012; Forecasting the future reimbursement system of Korean National Health Insurance: a contemplation focusing on global budget and Neo-KDRG-based payment systems. J Korean Med Sci. 27(Suppl):S25–32. DOI: 10.3346/jkms.2012.27.S.S25. PMID: 22661867. PMCID: PMC3360170.

8. Hennig-Schmidt H, Selten R, Wiesen D. 2011; How payment systems affect physicians' provision behaviour--an experimental investigation. J Health Econ. 30:637–46. DOI: 10.1016/j.jhealeco.2011.05.001. PMID: 21683460.

9. Shin SC, Kang GW, Kim SW. 2013; Simulation on the change of practice pattern after the introduction of 7 diagnosis-related groups prospective payment system in a university hospital. Health Policy Manag. 23:103–11. DOI: 10.4332/KJHPA.2013.23.2.103.

10. Lee C, Kim JM, Kim YS, Shin E. 2019; The Effect of diagnosis-related groups on the shift of medical services from inpatient to outpatient settings: a national claims-based analysis. Asia Pac J Public Health. 31:499–509. DOI: 10.1177/1010539519872325. PMID: 31516035.

11. Kim S, Yun YM, Kim H, Um TH, Chang J, Jeong H, et al. 2020; The new diagnosis-related group reimbursement system and laboratory test quality in Korea: analysis of external quality assessment results. Healthcare (Basel). 8:127. DOI: 10.3390/healthcare8020127. PMID: 32392746. PMCID: PMC7349770.

12. Shin H. Korea Institute for Health and Social Affairs (KIHASA). An evaluation study on the new diagnosis-related group payment system pilot program [Research Report]. http://repository.hira.or.kr/handle/2019.oak/2273. Updated on Jan 2020.

13. Kim Y. Seoul National University Research and Business Development Foundation.  A study on the calculation of adjustment factors by type in new diagnosis-related group payment system [Research Report]. http://www.alio.go.kr/popSusiViewB1040.do?seq=2017051101419330. Updated on Dec 2016.

14. Lee IS. 2018; Investigation and proposals of Korean diagnosis related group and patient classification system. Korean J Med. 93:231–6. DOI: 10.3904/kjm.2018.93.3.231.

15. Kim NR. Perception on new bundling payment program among physicians of regional public hospitals in Korea. http://dcollection.hanyang.ac.kr/jsp/common/DcLoOrgPer.jsp?sItemId=000000072048. Updated on Aug 2013.

16. Lee HR, Kim S, Yun YM, Heo JH, Lee KS, Jeong H, et al. 2020; Effects of the new diagnosis-related group-based payment system and the increased incentive policy rates on the utilization rate of diagnostic laboratory test in Korea. J Korean Med Assoc. 63:493–503. DOI: 10.5124/jkma.2020.63.8.493.