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Impact of a diagnosis-related group payment system on cesarean section in Korea
Seung Ju Kim1, Kyu-Tae Han1, Sun Jung Kim2
1Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
Insights
The diagnosis-related group (DRG)-based payment system in Korea was associated with fewer cesarean sections (CSs). A longer adoption period of this payment system correlated with a reduced likelihood of CS delivery.
Area of Science:
- Health Economics
- Obstetrics and Gynecology
- Public Health Policy
Background:
- Cesarean sections (CSs) represent the most costly delivery method, potentially influencing clinical decisions.
- The implementation of a diagnosis-related group (DRG)-based payment system aims to standardize healthcare costs and resource allocation.
Purpose of the Study:
- To investigate the impact of the DRG-based payment system on the rates of cesarean sections in South Korea.
- To analyze the association between the duration of DRG system adoption and the likelihood of cesarean delivery.
Main Methods:
- Utilized National Health Insurance claim data from 2011 to 2014, encompassing 1,289,989 delivery cases across 674 hospitals.
- Employed a generalized estimating equation model to assess the relationship between DRG adoption length and cesarean delivery rates.
Main Results:
- A total of 37.0% of deliveries were performed via CS.
- A longer DRG adoption period was significantly associated with a lower odds ratio for CS (OR: 0.997, 95% CI: 0.996-0.998).
- This association was consistent across voluntarily adopting hospitals, urban settings, and specific age groups (primiparas under 28 and over 33 years old).
Conclusions:
- The shift to a DRG-based reimbursement system in Korea was linked to a decrease in cesarean section rates.
- The findings suggest that healthcare reimbursement policies can influence provider decisions regarding delivery methods, with potential for increased impact over time.
Abstract:
Cesarean sections (CSs) are the most expensive method of delivery, which may affect the physician's choice of treatment when providing health services to patients. We investigated the effects of the diagnosis-related group (DRG)-based payment system on CSs in Korea. We used National Health Insurance claim data from 2011 to 2014, which included 1,289,989 delivery cases at 674 hospitals. We used a generalized estimating equation model to evaluate the association between the likelihood of cesarean delivery and the length of the DRG adoption period. A total of 477,309 (37.0%) delivery cases were performed by CSs. We found that a longer DRG adoption period was associated with a lower odds ratio of CSs (odds ratio [OR]: 0.997, 95% CI: 0.996-0.998). In addition, a longer DRG adoption period was associated with a lower odds ratio for CSs in hospitals that had voluntarily adopted the DRG system. Similar results were also observed for urban hospitals, primiparas, and those under 28 years old and over 33 years old. Our results suggest that the change in the reimbursement system was associated with a low likelihood of CSs. The impact of DRG adoption on cesarean delivery can also be expected to increase with time, as our finding provides evidence that the reimbursement system is associated with the health provider's decision to provide health services for patients.
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