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JungKyu Choi

JungKyu Choi

National Health Insurance Ilsan Hopital, South Korea

Title: The accuracy of payment about new-diagnosis related groups in Korea

Biography

Jung Kyu Choi has expertise in evaluating the policy regarding health insurance. He completed his bachelor and masters degree from Yonsei University, South Korea. Later on, he completed his PhD in public health from Yonsei University, South Korea. Currently, he is working at National Health Insurance ILSAN Hospital, South Korea

Abstract

Statement of the Problem: Korea set up new Diagnosis Related Group (DRG) as demonstration project in 2009. While there is a 'bundling part' having a per diem score by diagnosis, the 'non-bundled (fee-for-service) items' also exist. DRG consists of about 550 diseases group. DRG is running only in 40 hospitals due to a lack of consensus. Main purpose of study is to identify the change of accuracy of payment by DRG partition as compared with cost.

Methodology & Theoretical Orientation:  This study collected inpatient data from a hospital which contains medical information and cost from 2013 July to 2016 June. The accuracy of payment was classified the accuracy of total, bundled, unbundled and non-benefit payment. The accuracy of payment was calculated as payment divided by cost.

Findings: About 24,000 patients were hospitalized annually. The accuracy of total, bundled and unbundled payment increased 7.2%, 14.6%, and 3.8%. However, the accuracy of non-benefit payment decreased 27.3%. The accuracy of bundled payment showed the largest increase.

Conclusion & Significance: The results of study imply that the accuracy of payment was enhanced. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG