Governmental designation of spine specialty hospitals, their characteristics, performance and designation effects: a longitudinal study in Korea.
OBJECTIVE
This study compares the characteristics and performance of spine specialty hospitals versus other types of hospitals for inpatients with spinal diseases in South Korea. We also assessed the effect of the government's specialty hospital designation on hospital operating efficiency.


METHODS
We used data of 823 hospitals including 17 spine specialty hospitals in Korea.


METHODS
All spine disease-related inpatient claims nationwide (N=645 449) during 2010-2012.


METHODS
No interventions were made.


METHODS
Using a multilevel generalised estimating equation and multilevel modelling, this study compared inpatient charges, length of stay (LOS), readmission within 30 days of discharge and in-hospital death within 30 days of admission in spine specialty versus other types of hospitals.


RESULTS
Spine specialty hospitals had higher inpatient charges per day (27.4%) and a shorter LOS (23.5%), but per case charges were similar after adjusting for patient-level and hospital-level confounders. After government designation, spine specialty hospitals had 8.8% lower per case charges, which was derived by reduced per day charge (7.6%) and shorter LOS (1.0%). Rates of readmission also were lower in spine specialty hospitals (OR=0.796). Patient-level and hospital-level factors both played important roles in determining outcome measures.


CONCLUSIONS
Spine specialty hospitals had higher per day inpatient charges but a much shorter LOS than other types of hospitals due to their specialty volume and experience. In addition, their readmission rate was lower. Spine specialty hospitals also endeavoured to be more efficient after governmental 'specialty' designation.
Department of Public Health, Yonsei University College of Medicine, Seoul, South Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea.
Sun Jung
SJ
Kim
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, Wisconsin, USA.
Ji Won
JW
Yoo
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea.
Sang Gyu
SG
Lee
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea.
Tae Hyun
TH
Kim
Department of Public Health, Yonsei University College of Medicine, Seoul, South Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea.
Kyu-Tae
KT
Han
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Eun-Cheol
EC
Park
D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D005260:Female; D006076:Government; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D056910:Republic of Korea; D013122:Spinal Diseases / Q000191:economics / Q000628:therapy*
HEALTH SERVICES ADMINISTRATION & MANAGEMENT