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KMID : 0387320000100040020
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Korean Journal of Health Policy and Administration
2000 Volume.10 No. 4 p.20 ~ p.56
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A Critical Review of the Application Experiences of the DRG Reimbursement System in the USA
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Lee Sun-Hee
Choi Kui-Son
Jo Hee-Sook
Chae Yoo-Mi
Han Eun-A
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Abstract
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The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words “diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.
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KEYWORD
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DiDiagnosis-Related Groups(DRG), reimbursement system
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