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KMID : 0387320220320020154
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Korean Journal of Health Policy and Administration
2022 Volume.32 No. 2 p.154 ~ p.163
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Limitations and Improvement of Using a Costliness Index
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Jang Ho-Yeon
Kang Min-Seok
Jeong Seo-Hyun
Lee Sang-Ah
Kang Gil-Won
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Abstract
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Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and themanagement of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation inreflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It isdesirable to calculate the CI by integrating the medical cost into the episode unit.
Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare andMedicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost toepisode unit. Additionally, we compared our new method with the previous method.
Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatienttreatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of totalmedical costs of the patient unit in low volume medical institute and rural area has been underestimated.
Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may haveprovided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rateindicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-basedtreatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator isneeded.
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KEYWORD
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Costliness index, Episode grouper, Korean Diagnosis-Related Groups
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