요양병원 입원환자 분류체계 및 수가수준 정기적 조정기전 마련을 위한 기초연구

Abstract

Background: Over the next 10 years, there have been continuous issues related to the classification criteria and fees of inpatients in long-term care hospitals, such as an increase in the ratio of mild and long-term hospitalization, an increase in social hospitalization, and ambiguity in classification criteria. Accordingly, the 7th Health Insurance Policy Deliberation Committee in 2019 reorganized the health insurance fee system for long-term care hospitals from November 2019. At the same time, as a mid- to long-term reorganization plan, a new classification system was proposed to promote functional differentiation according to the disease group and severity of long-term care hospitals. Objective: The purpose of this study is to provide basic data to prepare a long-term care hospital inpatient classification system and a mechanism for adjusting the fee level by identifying problems with the long-term care hospital inpatient classification system and fee level and seeking improvement directions. Results: As of the date of reorganization of the classification system for inpatients in long-term care hospitals (November 1, 2019), 201,260 patients who were consecutively hospitalized were analyzed. The proportion of patients in the selective hospitalization group was expected to be 43.7% (87,928 patients) after the reorganization, but it was confirmed that only 11.4% (22,980 patients) after the actual reorganization. As a result, inpatients in long-term care hospitals could be classified into disease-based dementia, cerebrovascular and nervous systems, cancer, musculoskeletal system, and other patient groups. However, even within the first-stage classification group, additional reflective elements were needed to classify various patient conditions. Factors for detailed grouping, such as age classification, severity, number of days of hospitalization, whether to use a ventilator, and physical function, should be further reviewed to prepare a more specific classification system and fee system. Discussion: This study raised the need for a new classification system reflecting disease groups and patient conditions. It is necessary to understand the actual status of inpatients in long-term care hospitals through simulation studies applying objective functional evaluation tools in the future. It will be necessary to develop a disease group-based patient classification system that reflects objective indicators such as clinical diagnosis of patients, patient condition and function, and level of essential nursing behavior.