Variance of rates and Costs of Unplanned readmissions in tertiary Hospitals in south Korea Shin Min Sun1, Lee Won Jae2,*, Oh Hyun Sook3 1Researcher, Div. of Innovative Research, Health Insurance Review & Assessment Service 2Professor, Dept. of Healthcare Management, Gachon Univ. 3Professor, Dept. of Applied Statistics, Gachon Univ. *Corresponding Author: Won Jae Lee, Professor, Dept. of Healthcare Management, Gachon Univ. Email: health21@gachon.ac.kr
Online published on 8 August, 2019. Abstract This study attempted to estimate rates and costs of unplanned readmissions of high level hospitals Korea. Unplanned readmissions are used as a proxy of the quality of medical services. Korean Health Insurance reimburses tertiary hospitals 5% more fees than general hospitals. The gaps of the health insurance reimbursement rates are not based on the difference in quality of medical services among the level of hospitals. It needs to be reviewed whether the gaps are reflecting difference of the quality of medical services. The Health Insurance Claims Data of patients readmitted within 28 days after discharge from tertiary hospitals in 2014 were classified into unplanned claims. Unplanned readmissions were compared with planned readmissions. The risk-adjusted average readmission rate was 6.4% in all tertiary hospitals, but 5.7% in general hospitals with 500 beds or more. Coefficient of variance (CV) of readmission rate was higher in tertiary hospitals (32.8) than general hospitals with 500 beds or more (17.5). However, there was no significant difference in mean medical fees per unplanned readmission between two groups of hospitals. It was 3, 810 Won in the tertiary hospitals and 3, 834 Won in general hospitals with 500 beds or more. The findings of this study showed that higher costs did not necessarily yield higher quality of care, suggesting that quality control measures should be required to reduce unplanned readmissions in tertiary hospitals. Top Keywords Readmission, unplanned readmission, healthcare insurance, admission cost. Top |