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The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea
- Source :
- The European Journal of Public Health. 26:42-47
- Publication Year :
- 2015
- Publisher :
- Oxford University Press (OUP), 2015.
-
Abstract
- Background : The diagnosis-related group-based prospective payment programme was introduced in Korea in 1997 as a pilot programme to control health spending. In July 2013, the programme was implemented throughout the nation. The aim of our study is to evaluate the relationship between quality of care and market competition following the introduction of the new payment system in Korea. Methods : We conduct an observational analysis using National Health Insurance claim data from 2011 to 2014. We analyse data on readmission within 30 days, length of stay, and number of outpatient visits for 1742 hospitals and 821 912 cases. We use a generalized estimating equation model to evaluate readmission within 30 days and number of outpatient visits and a multi-level regression model to assess length of stay. Results : Total readmission within 30 days is 10 727 (1.3%). High competition areas present a lower risk of readmission [odds ratio (OR): 0.95, P : 0.0277], a longer length of stay (1%, P < 0.0001), and an increased number of outpatient visits (Relative Risk: 1.11, P : 0.0011) as compared with moderate competition areas. Risk of readmission is higher in low competition areas as compared with moderate competition areas (OR: 1.21, P < 0.0001). Conclusion: The effects of the introduction of the new payment system differed by degree of market competition. Thus, evaluation about the effect of new payment system on hospital performance should be measured in combination with the degree of hospital market structure.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
National Health Programs
media_common.quotation_subject
Payment system
Lower risk
Patient Readmission
Competition (economics)
Insurance Claim Review
03 medical and health sciences
0302 clinical medicine
Republic of Korea
Humans
Medicine
030212 general & internal medicine
Generalized estimating equation
Diagnosis-Related Groups
Quality Indicators, Health Care
Quality of Health Care
media_common
Economic Competition
business.industry
030503 health policy & services
Public Health, Environmental and Occupational Health
Regression analysis
Odds ratio
Length of Stay
Middle Aged
Payment
Relative risk
Female
0305 other medical science
business
Demography
Subjects
Details
- ISSN :
- 1464360X and 11011262
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- The European Journal of Public Health
- Accession number :
- edsair.doi.dedup.....f820cd198b169c61c42c438863db906d