병원의 전문화 수준에 따른 재원일수, 진료비 차이에 대한 연구 : 대장항문질환, 관절질환, 뇌혈관질환을 중심으로

Does Hospital Specialization Matter in Length of Stay and Inpatient Charges? Multilevel Analysis of Patients with Colon-rectal, Joint, and Cerebrovascular Diseases

This study investigated the relationship of hospital specialization with length of stay and inpatient medical charge using claims data of the Health Insurance and Review Assessment National Inpatient Sample from 2016 (HIRA-NIS-2016) for colon-rectal, joint, and cerebrovascular conditions. To this end, we employed multivariate hierarchical linear models using two-tier data from 78,693 patients discharged with colon and rectal conditions from 653 hospitals, from 16,409 patients discharged with joints conditions from 316 hospitals, 13,236 patients discharged with cerebrovascular conditions from 246 hospitals. Multivariate results indicate that patients who were discharged with colon-rectal and joint conditions from specialized hospitals stayed shorter and paid more inpatient charge than those who were discharged from less specialized hospitals, after controlling for patient demographic and clinical factors and hospitals’structural, operational and ecological factors. We also found that patients who were discharged with cerebrovascular conditions from specialized hospitals stayed longer and paid more inpatient charge than those who were discharged from less specialized hospitals. This finding suggests that one size does not fit all when it comes to the hospital specialization. We discussed several managerial and health policy implications below.

This study investigated the relationship of hospital specialization with length of stay and inpatient medical charge using claims data of the Health Insurance and Review Assessment National Inpatient Sample from 2016 (HIRA-NIS-2016) for colon-rectal, joint, and cerebrovascular conditions. To this end, we employed multivariate hierarchical linear models using two-tier data from 78,693 patients discharged with colon and rectal conditions from 653 hospitals, from 16,409 patients discharged with joints conditions from 316 hospitals, 13,236 patients discharged with cerebrovascular conditions from 246 hospitals. Multivariate results indicate that patients who were discharged with colon-rectal and joint conditions from specialized hospitals stayed shorter and paid more inpatient charge than those who were discharged from less specialized hospitals, after controlling for patient demographic and clinical factors and hospitals’structural, operational and ecological factors. We also found that patients who were discharged with cerebrovascular conditions from specialized hospitals stayed longer and paid more inpatient charge than those who were discharged from less specialized hospitals. This finding suggests that one size does not fit all when it comes to the hospital specialization. We discussed several managerial and health policy implications below.