title: Impact of payment system change from per-case to per-diem on high severity patient's length of stay.
abstract: A new payment system, the diagnosis-related group (DRG) system, and Korean diagnosis procedure combination (KDPC, per-diem) payment system were officially introduced in 2002 and in 2012, respectively. We evaluated the impact of payment system change from per-case to per-diem on high severity patient's length of stay (LOS).Claim data was used. A total of 36,240 case admissions and 72,480 control admissions were included in the analysis. Segmented regression analysis of interrupted time series between cases and controls was conducted. Hospitals that consistently participated in the DRG payment system and changed to the KDPC payment system were defined as case hospitals. Hospitals that consistently participated in the DRG payment system were defined as control hospitals.LOS increased by 0.025 days per month (P = 0.0055) for 3 surgical diagnosis-related admissions due to the bundled payment system change. LOS among emergency admissions also increased and showed an increasing tendency under the KDPC. The LOS increase was observed specifically for complex procedure admissions and high severity cases (CCI 0, 1: 0.022, P = 0.0142; CCI 2, 3: 0.026, P = 0.0288; CCI ≥ 4: 0.055, P = 0.0003).Although both payment systems are optimized to decrease LOS, incentives to reduce LOS are stronger under the DRG system than under the KDPC system. It is worth noting that too strong incentive for reducing LOS is suitable to high severity cases.
authors.affiliation: Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Severance Hospital Department of Hospital Management Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors.forename: Sung-In
authors.initials: SI
authors.lastname: Jang
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Sohee
authors.initials: S
authors.lastname: Park
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D055815:Young Adult