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KMID : 1235020200140020027
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Health Service Management Review
2020 Volume.14 No. 2 p.27 ~ p.36
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Empirical Study on the Association between Specialization and Operational Performance among Small and Midsize Hospitals: Focusing on Diseases and Disorders of the Digestive System under DRG Payment
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Seo Seul-Ki
Choi Jae-Young
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Abstract
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The aim of this study is to explore the associations between small and midsize hospital specialization and length of stay and inpatient medical charge using claims data of the Health Insurance and Review Assessment National Inpatient Sample from 2018 for anal surgery, hernia surgery, and appendectomy. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 4,970 patients discharged after anal surgery from 91 hospitals, from 378 patients discharged after hernia surgery from 73 hospitals, 856 patients discharged after appendectomy from 91 hospitals.
We found that patients who were discharged after anal surgery or hernia surgery from specialized small and midsize hospitals stayed shorter and paid more inpatient charge than those who were discharged from less specialized hospitals, after controlling for patient demographic and clinical factors and hospitals’structural, operational and contextual factors. Furthermore post-hoc analysis revealed that patients discharged after complex appendectomy from more specialized hospitals stayed shorter and paid more inpatient charge than those who discharged from less specialized hospitals. We discussed managerial and health policy implications below.
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KEYWORD
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Hospital Specialization, Length of Stay, Medical Expense
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