준실험적 방법을 이용한 DRG지불제도 참여효과

초록

The aim of this study was to examine the impact of the participation in the DRG-based payment system on the length of stay (LOS). As the participation was voluntary, this study controlled for endogeneity and selection bias. Using data from the longitudinal claims database from 2002 to 2007 for Cesarean Section (370DRG), Cataract (039DRG), Tonsillectomy/Adenoidectomy (059DRG), and Hemorrhoid procedures (157DRG), this study examined the LOS based on the Heckman‘s treatment effect model and Instrumental Variable regression model. Empirical results show that the DRG-based payment reduced the LOS, regardless of whether endogeneity is controlled for in the model. However, the magnitude of the impact of the DRG-based payment on the LOS is greater when the endogeneity is controlled for. This study shows that the DRG-based Prospective Payment system had positive impact on cost containment by reducing LOS. However, further study is necessary to examine the effect of DRG-based payment on total expenditure, mortality, quality of care, patient satisfaction etc.

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