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요양병원 입원환자 분류체계 및 수가수준 정기적 조정기전 마련을 위한 기초연구

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Type
Research report
Author(s)
이다희전인혜김명화김록영
Issued Date
2021-12
Keyword
HIRAHealth Insurance Review & Assessmentconvalescent hospitalpatient classification systemlong-term careinpatient
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.
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/3052
Alternative Title
A Basic study on developing Adjustment Mechanism for Classification system and Medical fee of Long-Term Care Hospital Inpatients
Table Of Contents
요 약 i

제1장 서 론 ---------------------------------- 1
1. 연구 배경 ---------------------------------- 1
2. 연구 목적 ---------------------------------- 2
3. 연구 내용 및 방법 ---------------------------------- 2

제2장 요양병원의 역할과 기능 고찰 ---------------------------------- 5
1. 요양병원 관련 정책 개요 ---------------------------------- 5
2. 요양병원 공급 및 이용 현황 ---------------------------------- 19
3. 급성기 의료기관 퇴원 후 환자의 이용 현황 ---------------------------------- 29
4. 요양병원의 문제점 ---------------------------------- 39

제3장 요양병원 입원환자 분류체계 현황 분석 ---------------------------------- 43
1. 분석 개요 ---------------------------------- 43
2. 환자분류체계 개편에 따른 예상 및 실제 분류군 비교 분석 ---------------------------------- 53
3. 예상 및 실제 환자분류군 불일치 대상자 분석 ---------------------------------- 57
4. 소결 ---------------------------------- 60

제4장 외국 사례 고찰 ---------------------------------- 63
1. 미국 ---------------------------------- 63
2. 캐나다 ---------------------------------- 80
3. 호주 ---------------------------------- 84

제5장 요양병원 입원환자 분류체계 개선 방안 ---------------------------------- 93
1. 질병군 기반 환자분류체계 개요 ---------------------------------- 93
2. 질병군 기반 환자분류체계 적용 가능성 검토 ---------------------------------- 95
3. 질병군 기반 환자분류체계 적용 방안 ---------------------------------- 128

제6장 결론 ---------------------------------- 135

참고문헌 ---------------------------------- 139
ABSTRACT ---------------------------------- 143
Publisher
건강보험심사평가원
Location
KOR
Citation
이다희 et al. (202112). 요양병원 입원환자 분류체계 및 수가수준 정기적 조정기전 마련을 위한 기초연구.
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