title: Impact of the new payment system on laparoscopic appendectomy in Korea.
abstract: BACKGROUND
  Korea has a nationalized health system. The aim of this study was to evaluate the impact of the Korea diagnosis related group-based prospective payment system (K-DRG/PPS) on the use of medical resources and the rate of adverse events during laparoscopic appendectomy.
  
  
  METHODS
  We included patients who underwent laparoscopic appendectomy at Dongtan Sacred Heart Hospital, Korea, between November 2012 and February 2014. The patients were divided into two groups: before-DRG/PPS or after-DRG/PPS groups. The length of the postoperative hospital stay (LOS) and medical costs were indicators of the medical resources. Medical costs included those of the initial hospital stay, outpatient clinic, readmission, and the sum of these charges. Complication and readmission rates were indicators of the rates of adverse events.
  
  
  RESULTS
  After the implementation of the DRG/PPS, length of the hospital stay decreased by 10% (4.9 d before versus 4.4 d after DRG/PPS; P < 0.001). The initial hospital stay and total cost were significantly lower in the after-DRG/PPS group (both P < 0.001). The complication rates during the initial hospital stay (3.5% before versus 2.3% after DRG/PPS; P = 0.225) and the readmission rates (4.3% versus 2.5%, respectively; P = 0.227) were statistically similar.
  
  
  CONCLUSIONS
  This study shows that the K-DRG/PPS for laparoscopic appendectomy had no negative effect on the rate of adverse events and reduced the use of medical resources. Further evaluation of other procedures is required to determine the overall effects of the K-DRG/PPS.
authors.affiliation: Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea.
authors.forename: Jong Wan
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea.
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea.
authors.forename: Jin Ju
authors.initials: JJ
authors.lastname: Chae
authors.affiliation: Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea.
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea. Electronic address: pmcgpark@hallym.or.kr.
authors.forename: Sung Gil
authors.initials: SG
authors.lastname: Park
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011445:Prospective Payment System; D056910:Republic of Korea / Q000453:epidemiology; D055815:Young Adult
keywords: Acute appendicitis; Diagnosis related group (DRG); Laparoscopic appendectomy; Prospective payment system (PPS)