Abstract
PurposeTo assess changes in clinical practice patterns after implementing diagnosis-related group (DRG) payment system in July 2013 and its effect on the quality of care for pelvic organ prolapse (POP).Materials and methodsUsing the 2011–2016 administrative database from National Health Insurance claim data, we reviewed medical information of 7362 patients who underwent hysterectomies for POP in Korean tertiary hospitals. We compared changes in several variables including length of stay, concomitant procedures, outpatient visits and readmission within 30 days after discharge, and retreatment for POP or stress urinary incontinence within postoperative 1 year before and after DRG system.ResultsAfter the introduction of DRG system, the average length of stay decreased (7.74 ± 2.88 to 6.63 ± 2.18 days, p<0.001) without increasing readmission rates. However, the number of outpatient visits increased (2.78±2.33 to 2.98±2.47, p<0.001). Regarding concomitant procedures, the rates of colpopexy and midurethral slings significantly decreased (7.87% and 9.84% to 4.93% and 2.93%, respectively, all p<0.001). Even though there was no difference in the reoperation rates, pessary insertion for recurrent POP significantly increased after the introduction of DRG system (0.10% to 0.38%, p = 0.015).ConclusionThe implementation of DRG in Korean tertiary hospitals has led to increase of outpatient visits and reduced surgical management for POP, which indicates that the uniform application of DRG influences the quality of care for POP patients.
Highlights
Since its introduction in 1977, the National Health Insurance Program in Korea has paid health care providers on a fee-for-service basis
Because diagnosis-related group (DRG) provides a fixed reimbursement for inpatient services, it encourages health care providers to reduce the length of stay or the intensity of services, which could influence the quality of care for patients
It has been reported that the implementation of the DRGbased payment system in the field of obstetrics and gynecology, with regard to cesarean section, hysterectomy, and adnexectomy, in Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission
Summary
Since its introduction in 1977, the National Health Insurance Program in Korea has paid health care providers on a fee-for-service basis. The fee-for-service reimbursement system has led to the rapid growth of health expenditures and changes in medical care such as the substitution of more profitable and less regulated services. To address these problems, the government adopted a pilot program utilizing diagnosis-related group (DRG) reimbursement for inpatient care in 1997. Because DRG provides a fixed reimbursement for inpatient services, it encourages health care providers to reduce the length of stay or the intensity of services, which could influence the quality of care for patients In spite of these concerns, several studies have reported that the Korean DRG system is effective in containing medical expenses with little negative impact on quality of care [1,2,3]. Decreases in the rates of concomitant colpopexy and midurethral slings at the time of hysterectomy were reported after introduction of the DRG [4]
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