정신건강의학과 환자 입원의료비에 있어 한국형 진단명기준 환자군분류체계의 의미와 한계

• 영문명: The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients Hospital Charges
• 발행기관: 대한신경정신의학회
• 저자명: 조근호 석정호 정운진 이병철 김애련 최은경 원보윤 이정석
• 간행물 정보: 『신경정신의학』제56권 제1호, 10~19쪽, 전체 10쪽
• 주제분류: 의약학 > 정신과학
• 파일형태: PDF
• 발행일자: 2017.02.28

영문 초록

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

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Diagnosis-Related Groups Hospital charge Health Insurance Classification of disease 진단명기준 환자분류체계 입원의료비 건강보험 질병분류