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KMID : 1033020200100010001
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Journal of Hemiology: Diagnosis and Treatment of Hernias
2020 Volume.10 No. 1 p.1 ~ p.7
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Changes in Approaches to Groin Hernia Repair before and after Diagnosis-Related Groups/Prospective Payment System Implementation in South Korea
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Jang Ho-Yeon
Kang Gil-Won
Park Jin-Woo
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Abstract
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Purpose: The South Korean Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) for groin hernia repairs (GHRs) was first implemented in 2012 and has undergone modifications ever since. We investigated changes in the choice of surgical approach and their consequences before and after DRG-PPS implementation for GHRs in South Korea.
Methods: We analyzed clinical data regarding approaches to GHRs from 2011 to 2015, using the Health Insurance Review and Assessment Service-National Inpatient Sample.
Results: A total of 20,203 patients underwent 20,462 GHRs, including 16,418 open (80.2%) and 4,044 laparoscopic repairs (LRs) (19.8%). The DRG-PPS was applied to about 30% of the cases before July 2012 but to almost 90% of the cases after July 2013, when the costs of LRs started to be properly reimbursed by the DRG-PPS. Overall, an increasing trend was observed toward laparoscopic GHR. The percentages of LRs during the first versus last 6 months of the study period for different age groups were as follows: 1.8% vs. 29.8% for children (age<15 years), 17.9% vs. 43.6% for youths, and 14.4% vs. 28.5% for the elderly (age>40 years). Moreover, the proportion of synchronous bilateral GHRs (BGHRs) was found to be well below 8% in both the young and elderly patient groups; however, in children?especially those undergoing LR?it rapidly increased from 9.4% at the beginning to 24.1% at the end of the study.
Conclusion: The choice of surgical approach to GHRs is affected by many factors including reimbursement systems. Recent changes in the Korean DRG-PPS for GHRs in favor of LRs appeared to facilitate a shift from open to laparoscopic repairs; in addition, they were found to promote synchronous BGHRs in children.
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KEYWORD
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Diagnosis-related groups, Groin, Hernia, Laparoscopy
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