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KMID : 1170320140200020067
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Korean Journal of Health Economics and Policy
2014 Volume.20 No. 2 p.67 ~ p.89
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Patient Cost Analysis in one general hospital for an enhancement of the Korean Diagnosis Related Group (KDRG) system
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Kim Han-Sung
Shin Jeong-Woo
Woo Jung-Sik
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Abstract
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This study proposes enhancements to the Korean Diagnosis Related Group (KDRG) system based on a Patient Cost Analysis. One general hospital’s cost recovery rate (=benefit/cost) of national health insurance beneficiaries was 88.0% in 2010. The cost recovery rate was dependent on the characteristics of patients; it was higher in the aged and higher for women. It also increased proportionally to ‘admission days’, ‘severity of patient’, and ‘treatment difficulty’. A variation of the cost recovery rate might lower the acceptance of the KDRG system. Health care providers have expressed concerns on the difficulties of hospital management due to the low benefits; however, government DRGs policies are predicted to face unique challenges. The empirical analysis has shown that the cost recovery rate was influenced by ‘admission days’, ‘inspection cost’, and ‘labor costs of doctors’. However, the cost recovery rate has a positive relationship with ‘inspection cost’ and a negative relationship to the ‘labor costs of doctors’. An imbalance of compensation level between surgical units and medical units seems to be due to labor and inspection costs. The cost recovery rate was high for medical units and low for surgical units. There is a need to establish a reasonable policy based on hospital cost analysis in order to solve the compensation level disparities under DRGs. Evidence can be found through ‘Panel Hospital’ which is emphasized recently.
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KEYWORD
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Patient cost analysis, cost recovery rate (compensation for hospital), Korean Diagnosis Related Group (KDRG), Panel hospital
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