중소병원의 전문화 전략과 운영성과의 관계에 대한 실증연구: 포괄수가제 대상 소화기계 질환을 중심으로

The aim of this study is to explore the associations between small and midsize hospital specialization and length of stay and inpatient medical charge using claims data of the Health Insurance and Review Assessment National Inpatient Sample from 2018 for anal surgery, hernia surgery, and appendectomy. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 4,970 patients discharged after anal surgery from 91 hospitals, from 378 patients discharged after hernia surgery from 73 hospitals, 856 patients discharged after appendectomy from 91 hospitals. We found that patients who were discharged after anal surgery or hernia surgery from specialized small and midsize 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 contextual factors. Furthermore post-hoc analysis revealed that patients discharged after complex appendectomy from more specialized hospitals stayed shorter and paid more inpatient charge than those who discharged from less specialized hospitals. We discussed managerial and health policy implications below.