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KMID : 1154920140090010025
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Korean Journal of Insurance Medicine
2014 Volume.9 No. 1 p.25 ~ p.38
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Evaluation of KDRG as a Patient Classification and Its Future Directions
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Kim Su-Jeong
Hong Hyeon-Su
Yun Mi-Ri
Yang Hun-Sik
Kim Sun-Woo
Kim Suk-Il
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Abstract
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The purpose of the study is to evaluate Korean Diagnosis Related Group (KDRG) as a patient classification and to suggest future directions. Korean healthcare system is well known to be one of the most cost-effectiveness ones even though fee-for-service is the main payment system of both hospitals and physicians. Because of its efficiency, it is not clear whether the introduction of DRG payment system would be benefit for patients and/or healthcare providers. DRG as a payment system should have been reasonable and sound as a patient classification. We found there are two premises for the introduction of DRG payment system around the world. (1) DRG payment system should be used only for the public hospitals except U.S. and some part of private sector in Australia and Germany. (2) When the DRG payment system is used for private hospitals, physician payment should be excluded from DRG payment system and DRG classification should be built on the hospital cost only. However, KDRG has several faults that make it not comparable with global patient classifications. (1) It is not built on the cost, but prices of services that has been controlled by the government and used for fee-for-service payment. (2) The KDRG classification included the payment for the physician’s service in the classification. Several problems caused by faulty classification were pointed out and three directions for the future were suggested. First, KDRG as a patient classification should be re-designed based on general principles for DRG building. Second, DRG payment system should be apply for public hospitals to ensure stability as a classification and the deficit caused by the immature classification system should be covered by the government. Lastly, Application of DRG payment system to the private hospitals should be considered after the two premises were met.
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KEYWORD
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Classification, Korean Diagnosis Related Group (KDRG)
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