The New Diagnosis-Related Group Reimbursement System and Laboratory Test Quality in Korea: Analysis of External Quality Assessment Results.

Korea introduced a new diagnosis-related group (NDRG), which is a mixed-bundle reimbursement system. We evaluated the effects of NDRGs on laboratory test quality by analyzing data over three years (2016-2018) from the Korean Association of External Quality Assessment Service (KEQAS). A total of 42 NDRG-participating hospitals (CASE), 84 non-participating similar size-hospitals (CON-1), and 42 tertiary hospitals (CON-2) were included. We assumed the proportion of KEQAS results with a larger than 2 standard deviation index (SDI) to be a bad laboratory quality marker (BLQM). CASE BLQMs were lower than CON-1 BLQMs for more than 2 years in alkaline phosphatase (ALP), alanine aminotransferase (ALT), chloride, glucose, sodium, and total protein, and higher in creatinine. CASE BLQMs were higher than CON-2 BLQMs for more than 2 years in ALP, chloride, creatinine, glucose, lactate dehydrogenase (LDH), phosphorus, potassium, sodium, total calcium, total cholesterol, triglyceride, and uric acid. Mean SDIs for general chemistry tests were not significantly different depending on NDRG participation. However, the NDRG is currently a pilot program that compensates the amount of each institution's reimbursement based on the fee-for-service system, and most participants were public hospitals. Thus, the effects of NDRGs on laboratory test quality should be re-evaluated after the NDRG program has stabilized and more private hospitals are participating.

Status of Quality Control for Laboratory Tests of Medical Institutions in Korea: Analysis of 10 Years of Data on External Quality Assessment Participation.

External quality assessment (EQA) is a commonly used tool to track the performance of laboratory tests. In Korea, EQA participation is not mandatory, and even basic data about EQA participation are not available. We used data of a 10-year period extracted from two databases (2009-2018): (1) the database of the National Health Insurance Service to calculate the number of medical institutions that claimed health insurance benefits, and (2) the database of the Korean Association of External Quality Assessment Service to calculate the number of medical institutions participating in EQA. The proportion of institutions that made claims for the performance of laboratory testing throughout the 10 years were 73.6%-76.0% for clinics, 91.9%-97.5% for long-term care hospitals, 97.9%-99.5% for small to medium hospitals, 99.6%-100% for general hospitals, and 100% for tertiary hospitals. The mean EQA participation rate of institutions that performed laboratory testing for the 10 years was 1.9% for clinics, 3.1% for long-term care hospitals, 27.7% for small to medium hospitals, 96.6% for general hospitals, and 100% for tertiary hospitals. The mean EQA participation of clinics, long-term care hospitals, and small to medium hospitals are increasing but is still not sufficient. Regulatory approaches are needed to increase participation rates. This result would be used for health policymaking on the quality improvement of laboratory tests.