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Variation of Hospital Costs and Product Heterogeneity

Shin, Young-Soo   (College of Medicine, Seoul National University Department of Preventive MedicineUU0000691  );
  • 초록

    The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 tim


 저자의 다른 논문

  • 신영수 (49)

    1. 1971 "공해(公害)에 관(關)한 조사연구(調査硏究) 제일편(第一編) : 서울, 부산(釜山), 대구(大邱) 지역(地域)의 대기오염(大氣汚染) 및 소음(騷音)에 관(關)한 비교조사(比較調査) 연구(硏究)" 예방의학회지 = Korean journal of preventive medicine 4 (1): 41~64    
    2. 1971 "공해(公害)에 관(關)한 조사연구(調査硏究) 제이편(第二編) 한강(漢江), 낙동강(洛東江) 수질오염도(水質汚染度)에 관(關)한 비교(比較) 조사(調査) 연구(硏究)" 예방의학회지 = Korean journal of preventive medicine 4 (1): 65~76    
    3. 1973 "일부 사형의 체격 및 체력에 관한 연구" 예방의학회지 = Korean journal of preventive medicine 6 (1): 87~99    
    4. 1983 "일산화탄소중독(一酸化炭素中毒)의 진료대책(診療對策) 수립(樹立)을 위한 추계학적(推計學的) 연구(硏究)" 예방의학회지 = Korean journal of preventive medicine 16 (1): 135~152    
    5. 1984 "급성일산화탄소중독(急性一酸化炭素中毒)의 신경학적(神經學的) 후유증(後遺症)에 관(關)한 역학적(疫學的) 연구(硏究)" 예방의학회지 = Korean journal of preventive medicine 17 (1): 5~24    
    6. 1984 "바람직한 병원 경영의 좌표-병원경영환경의 현실태와 개선방향을 중심으로" 대한병원협회지 = Journal of the Korean Hospital Association 13 (2): 22~25    
    7. 1985 "보건의료분야에서의 O.R의 응용" 經營 科學의 應用 2 (): 39~47    
    8. 1985 "연탄(煉炭)가스중독(中毒)의 발생실태(發生實態)에 관(關)한 연구(硏究)" 예방의학회지 = Korean journal of preventive medicine 18 (1): 1~11    
    9. 1987 "DRG가 병원에 미치는 영향(상)" 대한병원협회지 = Journal of the Korean Hospital Association 16 (6): 4~15    
    10. 1987 "DRG가 병원에 미치는 영향 (중)" 대한병원협회지 = Journal of the Korean Hospital Association 16 (7): 4~11    

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