신포괄수가제와 공익성이 종합병원의 수익성에 미치는 영향 = The Effect of New Diagnosis-Related Group-Based Payment and Public Interest on the Profitability of General Hospitals

다국어 초록 (Multilingual Abstract)

Diagnostics-Related Group-Based Payment(DRG), introduced to solve over-treatment problems such as excessive length of hospital stay and drug abuse under Fee-For-Service(FFS), is a system that compensates only a certain amount of medical expenses set in advance for the same disease regardless of the type or amount of medical services based on the FFS. DRG in Korea was first introduced in 2002, and since July 2013, it has been expanded to general hospitals and upper general hospitals for seven diseases and has been applied for granted. Since DRG compensates only a certain amount of money for a single disease and causes a problem of deteriorating quality of medical services, New Diagnosis-Related Group-Based Payment (NDRG) was introduced to solve this problem. In other words, NDRG is a system that applies DRG for basic treatment and FFS to compensate for expensive medical services and doctors' actions in order to solve the problem of over-treatment by FFS and deteriorating quality of medical services by DRG. With all general hospitals that disclosed financial statements to KHIDI from 2017 to 2019 set as research subjects, this study verified the influence of participation status in NDRG and public interest on profitability. First, participating in NDRG is expected to improve the profitability of general hospitals, since high-priced services and doctor’s actions are compensated with FFS and incentives are provided through evaluation, general hospitals participating in NDRG may show higher profitability than general hospitals that do not. Therefore, hypothesis I was established that 'whether or not to participate in NDRG will affect the profitability of general hospitals'. As a result, participation status of NDRG did not significantly affect both the Operating Profit on Assets and the Operating Margin of the entire sample group, indicating that the hospital's overall participation status of NDRG had a weak effect on profitability. Second, the number of hospital stays that decreased with the introduction of DRG to reduce costs increased again with the introduction of NDRG that compensates expensive medical services with FFS. This mainly appeared in private hospitals. Therefore, since the effect of profit improvement through increase in the number of hospital stays, with the introduction of NDRG, is expected to appear more in private general hospitals than in public general hospitals. Therefore the hypothesis II was established: "The impact of participation in NDRG of public hospitals on profitability will be different from that of private hospitals.". As a result, participation in NDRG improved the profitability of private general hospitals, but did not improve the profitability of public general hospitals. Third, non-metropolitan hospitals differ in profitability due to differences in geographic location and labor costs compared to general hospitals in the metropolitan area and relatively have stronger public interest than them. Therefore, since the impact of participation in NDRG on the profitability of general hospitals is expected to differ between non-metropolitan hospitals and general hospitals in the metropolitan area, hypothesis III was established: "The effect of participation in NDRG of non-metropolitan hospitals on profitability will be different from that of general hospitals in the metropolitan hospitals.” As a result, it was shown that whether or not the metropolitan area had no effect on the profitability of participation in NDRG. And participation of NDRG worsened the medical profit margin of non-metropolitan hospitals. Fourth, there were 42 general hospitals participating in NDRG before August 2018, and 26 hospitals from then to 2019, so only 26 hospitals/year were changed to NDRG from 2017 to 2019. Therefore, in order to verify Hypothesis I, As a result, general hospitals that changed to NDRG showed higher total asset medical returns than non-modified general hospitals, and there was no difference in prof...

국문 초록 (Abstract)

본 연구는 2017년부터 2019년까지 한국보건산업진흥원에 재무제표를 공시한 전체 종합병원들을 연구대상으로, 신포괄수가제 참여 여부와 공익성 여부가 수익성에 어떠한 영향을 미치는지를 검증하였다. 본 연구의 구체적인 분석결과는 다음과 같다. 첫째, 신포괄수가제 참여 여부는 전체 표본집단의 총자산의료이익률과 의료수익의료이익률에 모두 유의한 영향을 미치지 못하는 것으로 나타나, 종합병원 전체적으로 신포괄수가제 참여 여부가 수익성에 미치는 영향이 미약함을 보여주었다. 둘째, 신포괄수가제 참여는 민간종합병원의 수익성을 개선시키지만 공공종합병원의 수익성을 개선시키지는 못하였다. 셋째, 수도권 및 광역권 여부는 신포괄수가제 참여 여부의 수익관련성에 미치는 영향이 없음을 보여주었고, 신포괄수가제 참여가 비수도권종합병원들의 의료수익의료이익률을 악화시켰다. 넷째, 신포괄수가제로 변경한 종합병원이 비변경한 종합병원보다 총자산의료이익률이 높은 것으로 나타났고 의료수익의료이익률은 차이가 없었다. 본 연구의 의의는 신포괄수가제에 참여한 민간종합병원의 수익성이 개선되었음을 보여줌으로써, 공공종합병원과 비교하여 신포괄수가제 참여가 저조한 민간종합병원의 참여 타당성을 보여주었다는데 있다. 또한 신포괄수가제 참여가 공공종합병원, 비수도권종합병원과 비광역권종합병원들의 수익성을 개선시키지 못함을 보여줌으로써, 공익성을 담당하는 종합병원들에 대해 신포괄수가제 참여에 대한 재정적 지원이 더 필요함을 시사한다.

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