J Korean Neuropsychiatr Assoc.  2017 Feb;56(1):10-19. 10.4306/jknpa.2017.56.1.10.

The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges

Affiliations
  • 1Department of Mental Health Services, National Center for Mental Health, Seoul, Korea. knozodr@hanmail.net
  • 2Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
  • 3Maeumsarang Hospital, Wanju, Korea.
  • 4Department of Psychiatry, College of Medicine, Hallym University, Chuncheon, Korea.
  • 5Department of Classification System Management, Health Insurance Review & Assessment Service, Seoul, Korea.
  • 6Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Abstract


OBJECTIVES
This study was conducted to investigate whether the charges associated with Korean Diagnosis-Related Groups for mental health inpatients adequately reflect the degree of medical resource consumption for inpatient treatment in the psychiatric ward.
METHODS
This study was conducted with psychiatric inpatients data for 2014 from the National Health Insurance claim database. The main diagnoses required for admission, classification of the hospitals, and main treatment services were analyzed by examining descriptive statistics. Homogeneities of the major diagnostic criteria were assessed by calculating coefficient variances. Explanation power was determined by R2 values.
RESULTS
The most frequent disorders for psychiatric inpatient treatment were alcohol-use disorder, depressive episodes, bipolar affective disorder, and dementia in Alzheimer's disease. Hospitalization and psychotherapy fees were the main medical expenses. Regardless of the homogeneity of the disease group, duration of hospital stay was the factor that most influenced medical expenses. In the psychiatric area, explanation power of Korean Diagnosis-Related Groups was 16.52% (p<0.05), which was significantly lower than that for other major diagnostic area.
CONCLUSION
Most psychiatric illnesses are chronic, and the density of services can vary depending on illness severity or associated complications. The current Korean Diagnosis-Related Groups criteria did not adequately represent the amount of in-hospital medical expenditures. A novel Korean classification system that reflects the expenditures of medical resources in psychiatric hospitals should be developed in order to provide appropriate reimbursements.

Keyword

Diagnosis-Related Groups; Hospital charge; Health Insurance; Classification of disease
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