- -2002-56 2002 11 KOREA HEALTH INDUSTRY DEVELOPMENT INSTITUTE
. 2002 11 : ( ) : ( ) ( ) ( ) ( ) ( ) ( ) ( )
/ 1 / 1 1. 1 2. 2 3. 3 2 / 8 1. 8 2. 17 3 / 23 1. 23 2. 25 3. 47 4 / 50 1. 50 2. 52 3. 57 4. 72 5 / 90 1. 90 2. 101 i
6 / 118 1. 118 2. 123 3. 134 4. 140 7 / 153 1. 153 2. 162 3. 166 4. 2003 167 / 175 1. 177 2. 201 3. 2002 228 4. 230 ii
2-1 17 3-1 24 3-2 25 3-3 26 3-4 27 3-5 27 3-6 28 3-7 1 30 3-8 / 31 3-9 32 3-10 1 32 3-11 33 3-12 / 34 3-13 / 35 3-14 36 3-15 37 3-16 / 38 3-17 39 3-18 40 3-19 41 3-20 42 3-21 43 3-22 44 4-1 53 4-2 54 4-3 54 4-4 55 4-5 56 iii
4-6 ADRG 57 4-7 4-8 4-9 ADRG (10 ) 60 ADRG (10 ) 61 ADRG (4 ) 62 4-10 ADRG (4 ) 62 4-11 ADRG (4 ) 63 4-12 RDRG (10 ) 64 4-13 RDRG (10 ) 64 4-14 65 4-15 66 4-16 66 4-17 67 4-18 68 4-19 68 4-20 69 4-21 69 4-22 RDRG (10 ) 70 4-23 RDRG (10 ) 71 4-24 RDRG 71 4-25 RDRG 72 4-26 ADRG (10 ) 73 4-27 ADRG (10 ) 73 4-28 ADRG (10 ) 74 4-29 ADRG (10 ) 75 4-30 ADRG (10 ) 75 4-31 ADRG (10 ) 76 4-32 ADRG (10 ) 76 4-33 ADRG (10 ) 77 4-34 ADRG (10 ) 77 4-35 ADRG,, (10 ) 78 4-36 ADRG,, (10 ) 78 iv
4-37 (10 ) 79 4-38 (10 ) 80 4-39 (10 ) 80 4-40 (10 ) 81 4-41 (10 ) 81 4-42 (10 ) 82 4-43,, (10 ) 82 4-44 83 4-45 83 4-46 83 4-47 84 4-48 84 4-49 84 4-50 85 4-51 85 4-52 85 4-53 86 4-54 87 5-1 5-2 5-3 ( ) 92 ( ) 93 (2000 4 1 ) 95 5-4 116 6-1 122 6-2 122 6-3 123 6-4 125 6-5 130 6-6 135 6-7 135 6-8 136 6-9 136 v
6-10 137 6-11 137 6-12 144 6-13 144 6-14 2001 145 6-15 146 6-16 147 6-17 147 6-18 148 6-19 148 6-20 149 6-21 149 6-22 150 6-23 151 7-1 158 vi
1-1 5 2-1 9 4-1 51 5-1 104 5-2 106 5-3 114 6-1 133 vii
1. 2000 1, 2001 4 30 2001 5 2002 12 1 - - - - - - 2. 2. 1,,
,,. 2 3 32 3 2.2,,,., 1 ( - / - ),
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.. 3. 2001 5 2002 6 3. 1 30 17 57%. 6 1. 35%. 30.6 10.8. 2 3 3) 17 96, 201 297. 6, 12, 18 (2001.5 2002.6 : 14 ) 17 25 1.8. 3) 17 10
700, 300, 1,000 0.69% 70% 60% ( ), 60% 2. 3.2 (`01 5 95.0%, `01 7 82.4%, `02 7 93.8%). 2001,
(70% ) 52.2% 21.8%. 4., 2001 5 2002 5 10 47,420, DRG(Dignosis Related Group) 12.7, 19.4. 7.1,.,,,, 60 70, ADRG ADRG 59 (Tonsilectomy &/or Adenoidectomy). 10 ADRG
RDRG, 6 RDRG, 3 RDRG. RDRG 26.4%, 1 20.6%. RDRG 20.7%, 1 12.8%,,,,,.,,,,..,. episode..
5. 5. 1 1999 8,200 333 4.1%,,, (21.8%). 100 399 68.5%. 1987 70..,, 3.,.,,, 5.2
. (Medical Staff Organiazion : MSO) MSO (Physician fee) (Hospital fee) (Physician Office) (My Doctor) 4). (Hospitalist) 6. 6. 1 (Key Success Factors),,,.. ( ) 4) 1 (Primary Care Physician, PCP),, 1
- - 5 - - 10 6.2 1% 0.15%, 0.21%, 0.1% 10% 1.53%, 2.06%, 1.03%, 20% 3.06%, 4.12%, 2.06%. 40% 6.11%, 8.24%, 4.12% 5% 43, 12 41.7%, 1,345,901 10% 87, 870 41.7% 2,723,102. 1 41.7%, 4,319,403 703,050 (43 ), 1,422,450 (87 ), 2,256,300 (138 ),.,
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1 7 1994, 1997, 2000, 2002 4),, Consensus Building Method
8 2 1. 1. 1,,,, 1) 2 3,. 32 3. ( ) ( ) ( ), ( ) ( ) ( ) ( 1),, 2001
2 9 ) ( ) 2-1 1.2.... (closed hospital system), (open hospital system).,, (attending physicians).
10.,,. ( ),.., 1998. (Trustee), (Managers), (Physician, Nurses)..,,. (Medical Staff Organization)...
2 11.,,.,, ( ). ( ).,., ( ).. (Hospitalist) ( 5 ) ( ).. 1998
12 1.3 1),.....,.....,
2 13..., 3 3..,.,.......... 2).,
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2 15 3)........ 4).,
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2 17 2-1 ( - / - ), 2. 2. 1 1993. 1 2 1994
18,. 1994. 1999. 32 3 2000.. 2001 2001 4 30 2000, 2001 2002., 2002 1994 2000 2,
2 19 2.2 1) 1 2 2). ( ) ( ).. Moving Target 70 80%.. 3). (Sustainable), 2),, 2001 3)
20., 4).. - ( - ) 2).. (Clarity ) (Con sisten cy ).. (Desir ab ility ),,.,, 3 4) : 2002 ( ) http:// www.mhlw.go.jp/ wp/ seisaku/jigyou/jizen/ isei.html#09
2 21.. 3) - :, (, ) - :,,. - -, 1 2 3 -, -,
22 1 (Consistency). (Networking). ( ) 5).... 4)... 5), ( )
3 23 3 1. 1. 1 1) 2000 1, 2001 4 30 2002 12 1 3 30 9 (30%), 6 (20%), 15 (50%), 200 2, 201 400 12, 401 700 12, 701 4 401 53.3% 400 14 46.7%
24 3-1 30 9 6 15 2 1 1 3 1 2, 2 1 1 2 1 1 2 1 1 1 1 1 1 3 1 1 1 2 1 1 2 1 1 1 1 2 1 1 2 1 1 2 1 1 2 2, 1 1 2) 18 2001 2000 2.4% 2000 5.6% 8.4% 2000 7, 2001
3 25 3-2 ( : %, ) 2000 200 1 2000 200 1 83.5 75.1-8.4 9 7 82.5 81.5-1.0 14 7 78.6 84.2 5.6 6 4 82.0 79.6-2.4 29 18 2. 2. 1 1) (2001 5 2002 6 ) 2). 2001 4 30 1 21. 17 4 2001 5 6 2001 10 31 ( )
26 3-3 (2002 6 ) 22 8[7] 1(1) 13(3) 2 1 1 2 2, 1 1 2 1 ( ) 1 1 1 ( ) 1 1 ( ) 2 1 1 ( ) 2 1 1 2 1 1 1 1 2 1 1 1 1 2 2, 1 [1 ] ( ) ( ) 9 7, 6 1. 15 13 9 2001 2000
3 27 2001 ( 3-2),, 3-4 (%) (%) 9 7 77.8 7 77.8 6 1 16.7 - - 15 13 86.7 10 66.7 30 21 70.0 17 56.7. 2001 4 30 1 21 ( ) 3-5 ( :, ) 7 218 9.1 31.1 1 3 3.0 3.0 13 317 5.1 24.4 21 538 6.5 25.6 59.7% 37.2%,,,,,,,
28 3-6 ( :, %) 538 25.6 100.0 200 9.5 37.2 321 15.3 59.7 17 0.8 3.2 4 0.2 0.7 127 6.0 23.6 33 1.6 6.1 11 0.5 2.0 3 0.1 0.6 15 0.7 2.8 7 0.3 1.3 25 1.2 4.6 58 2.8 10.8 13 0.6 2.4 34 1.6 6.3 11 0.5 2.0 29 1.4 5.4 47 2.2 8.7 92 4.4 17.1 7 0.3 1.3 5 0.2 0.9 17 0.8 3.2 ( ) 2001 5 2002 6 21, 2001 6 395, 2001 3/4 0.8% 2001 4/4 2002 15.1% 17.5%
3 29 ( :, %) 3-1. 17 10 2002 7 16 (n=10) 10 30.6 1 10.8 35.3% 7.8 72.2% 3.0 27.8% 10.8 6.5 13.0
30 3-7 1 ( :, %) 306 30.6 108 10.8 100.0 35.3 122 12.2 30 3 27.8 24.6 172 17.2 78 7.8 72.2 45.3 12 1.2 - - - - 80 8 16 1.6 14.8 20.0 24 2.4 7 0.7 6.5 29.2 3 0.3 1 0.1 0.9 33.3 9 0.9 6 0.6 5.6 66.7 6 0.6 - - - - 23 2.3 7 0.7 6.5 30.4 40 4 12 1.2 11.1 30.0 14 1.4 14 1.4 13.0 100.0 8 0.8 4 0.4 3.7 50.0 18 1.8 12 1.2 11.1 66.7 22 2.2 9 0.9 8.3 40.9 39 3.9 15 1.5 13.9 38.5 6 0.6 3 0.3 2.8 50.0 2 0.2 2 0.2 1.9 100.0 12 1.2 - - - - ( ) 16 10. 2001 5 2002 6 17 1,338, 2,817 4,155 96, 201 297
3 31 6, 12 18 3-8 / ( : ) 0 1 5-6 0 1 3 0 1 4 02 1~ 6 17 4,155 667 777 879 1,832 1,338 341 246 253 498 2,817 326 531 626 1,334 297 334 259 293 305 96 171 82 84 83 201 163 177 209 222 89 100 78 88 92 56 100 48 49 49 123 100 109 128 136 18 20 15 17 18 6 10 5 5 5 12 10 10 12 13 ( ) 2001 5 2002 6 17 ( ) 2001 5 6 100 1,729,527, 770,766 (17 ) 2,500,293 7,267, 3,239, 10,505 1%
32 3-9 ( :, %) 0 1 5-6 0 1 3 0 1 4 02 1~ 6 2,500,293 335,181 509,692 581,230 1,074,191 1,729,527 278,239 352,512 383,655 715,122 770,766 56,942 157,180 197,575 359,069 178,592 167,591 169,897 193,743 179,032 123,538 139,120 117,504 127,885 119,187 55,055 28,471 52,393 65,858 59,845 107 100 101 116 107 89 100 84 92 86 193 100 184 231 210 10,505 9,858 9,994 11,397 10,531 7,267 8,184 6,912 7,523 7,011 3,239 1,675 3,082 3,874 3,520 ( ) 2001 5 2002 6 17 ( ) 2001 5 6 100 1 1,293, 1 274 3-10 1 ( : ) 0 1 5-6 0 1 3 0 1 4 02 1~ 6 602 503 656 661 586 1,293 816 1,433 1,516 1,436 274 175 296 316 269. 51.8% 48.2% 71.7% 28.3%,
3 33 42.4% 57.6%, 3-11 ( :, ) 4,155 1,338 2,817 2,500,293 1,729,527 770,766 2,153 959 1,194 1,418,007 1,200,186 217,821 2,002 379 1,623 1,082,286 529,341 552,944 244 79 166 147,076 101,737 45,339 308 137 171 202,572 171,455 31,117 200 38 162 108,229 52,934 55,294 ( ) 2001 5 2002 6 17 1 2 50%. 2 86%(823 ) 27 38 85% 28
34 3-12 / ( : ) 4,155 100.0 1,338 100.0 2,817 100.0 2,153 51.8 959 71.7 1,194 42.4 2,002 48.2 379 28.3 1,623 57.6 56 1.3 21 1.6 35 1.2 40 1.0 21 1.6 19 0.7 45 1.1 45 3.4 0 0.0 35 0.8 34 2.5 1 0.0 1,342 32.3 462 34.5 880 31.2 274 6.6 15 1.1 259 9.2 361 8.7 361 27.0 0 0.0 97 2.3 12 0.9 85 3.0 5 0.1 5 0.4 0 0.0 38 0.9 6 0.4 32 1.1 50 1.2 25 1.9 25 0.9 30 0.7 30 2.2 0 0.0 1,490 35.9 116 8.7 1,374 48.8 83 2.0 65 4.9 18 0.6 195 4.7 108 8.1 87 3.1 8 0.2 6 0.4 2 0.1 6 0.1 6 0.4 0 0.0 ( ) 2001 5 2002 6
3 35 3-13 / ( : ) 4,155 1,338 2,817 712 643 69 2,696 320 2,376 100.0 32.2 67.8 17.1 15.5 1.7 64.9 7.7 57.2 2,153 959 1,194 507 469 38 1,326 157 1,169 100.0 44.5 55.5 23.5 21.8 1.8 61.6 7.3 54.3 2,002 379 1,623 205 174 31 1,370 163 1,207 100.0 18.9 81.1 10.2 8.7 1.5 68.4 8.1 60.3 56 21 35 2 2-23 - 23 100.0 37.5 62.5 3.6 3.6-41.1-41.1 40 21 19 17 17-93 69 24 100.0 52.5 47.5 42.5 42.5-232.5 172.5 60.0 45 45-28 28-32 32-100.0 100.0-62.2 62.2-71.1 71.1-35 34 1 34 29 5 50-50 100.0 97.1 2.9 97.1 82.9 14.3 142.9-142.9 1,342 462 880 235 202 33 802 2 800 100.0 34.4 65.6 17.5 15.1 2.5 59.8 0.1 59.6 274 15 259 8 8-277 5 272 100.0 5.5 94.5 2.9 2.9-101.1 1.8 99.3 361 361-183 183-49 49-100.0 100.0-50.7 50.7-13.6 13.6-97 12 85 3 3-19 - 19 100.0 12.4 87.6 3.1 3.1-19.6-19.6 5 5-5 5 - - - - 100.0 100.0-100.0 100.0 - - - - 38 6 32 5 5-32 - 32 100.0 15.8 84.2 13.2 13.2-84.2-84.2 50 25 25 36 22 14 28 16 12 100.0 50.0 50.0 72.0 44.0 28.0 56.0 32.0 24.0 30 30-30 30 - - - - 100.0 100.0-100.0 100.0 - - - - 1,490 116 1,374 36 35 1 1,153 94 1,059 100.0 7.8 92.2 2.4 2.3 0.1 77.4 6.3 71.1 83 65 18 52 50 2 67 50 17 100.0 78.3 21.7 62.7 60.2 2.4 80.7 60.2 20.5 195 108 87 31 17 14 68-68 100.0 55.4 44.6 15.9 8.7 7.2 34.9-34.9 8 6 2 2 2-3 3-100.0 75.0 25.0 25.0 25.0-37.5 37.5-6 6-5 5 - - - - 100.0 100.0-83.3 83.3 - - - - ( ) 2001 5 2002 6
36 2 3 50% 62.1%, 51.7% 3-14 ( : ) 2,500,293 100.0 1,729,527 100.0 770,766 100.0 1,418,007 56.7 1,200,186 69.4 217,821 28.3 1,082,286 43.3 529,341 30.6 552,944 71.7 15,190 0.6 11,366 0.7 3,824 0.5 55,004 2.2 50,761 2.9 4,243 0.6 26,126 1.0 26,126 1.5 0 0.0 17,840 0.7 15,165 0.9 2,675 0.3 1,016,255 40.6 843,379 48.8 172,876 22.4 57,217 2.3 23,014 1.3 34,203 4.4 230,376 9.2 230,376 13.3 0 0.0 48,933 2.0 19,803 1.1 29,130 3.8 5,269 0.2 5,269 0.3 0 0.0 19,524 0.8 5,624 0.3 13,900 1.8 107,647 4.3 34,769 2.0 72,878 9.5 66,273 2.7 66,273 3.8 0 0.0 615,496 24.6 217,054 12.5 398,442 51.7 135,556 5.4 129,353 7.5 6,203 0.8 69,172 2.8 36,780 2.1 32,391 4.2 2,770 0.1 2,770 0.2 0 0.0 11,646 0.5 11,646 0.7 0 0.0 ( ) 2001 5 2002 6
3 37.,,,,,,,,,,,,,,. 3-15 ( : ) 0 1 5-6 0 1 3 0 1 4 02 1~ 6 4,155 100.0 667 777 879 1,832 1,355 32.6 260 228 274 593 2,577 62.0 378 549 605 1,045 223 5.4 29 - - 194 598 14.4 33 129 151 285 289 7.0 176 26 24 63 179 4.3 17 22 80 60 59 1.4-4 6 49 209 5.0 33 42 9 125 21 0.5 1 5 4 11 58 1.4 11 11 11 25 120 2.9 34 26 20 40 969 23.3 168 218 291 292 77 1.9 13 2 21 41 280 6.7 40 62 51 127 571 13.7 29 115 117 310 398 9.6 65 100 74 159 13 0.3-2 - 11 91 2.2 18 13 20 40 223 5.4 29 - - 194 ( ) 2001 5 2002 6 17
38 3-16 / ( :, %) 770,766 100.0 1,729,527 100.0 2,500,293 100.0 237,531 30.8 644,280 37.3 881,811 35.3 494,560 64.2 1,085,247 62.7 1,579,807 63.2 38,674 5.0 - - 38,674 1.5 163,717 21.2 128,100 7.4 291,817 11.7 6,005 0.8 71,667 4.1 77,672 3.1 59,483 7.7 129,853 7.5 189,337 7.6 4,576 0.6 2,947 0.2 7,523 0.3 1,848 0.2 311,517 18.0 313,365 12.5 1,902 0.2 195 0.0 2,097 0.1 9,244 1.2 7,317 0.4 16,561 0.7 3,334 0.4 76,959 4.4 80,293 3.2 168,440 21.9 353,909 20.5 522,349 20.9 20,793 2.7 6,501 0.4 27,294 1.1 16,669 2.2 144,793 8.4 161,462 6.5 123,792 16.1 228,455 13.2 352,247 14.1 138,053 17.9 208,744 12.1 346,797 13.9 305 0.0 22,753 1.3 23,058 0.9 13,930 1.8 35,816 2.1 49,746 2.0 38,674 5.0 - - 38,674 1.5 ( ) 2001 5 2002 6 17
3 39 3-17 ( :, %) 4,155 2,817 1,338 2,696 2,376 320 712 69 643 100.0 67.8 32.2 64.9 57.2 7.7 17.1 1.7 15.5 1,355 752 603 673 612 61 3-3 100.0 55.5 44.5 49.7 45.2 4.5 0.2-0.2 2,577 1,842 735 1,800 1,541 259 709 69 640 100.0 71.5 28.5 69.8 59.8 10.1 27.5 2.7 24.8 223 223-223 223 - - - - 100.0 100.0-100.0 100.0 - - - - 598 478 120 455 413 42 3-3 289 72 217 33 33 - - - - 179 116 63 121 103 18 - - - 59 56 3 56 56 - - - - 209 10 199 8 7 1 - - - 21 20 1 - - - - - - 58 51 7 19 15 4 8 2 6 120 38 82 59 29 30 75 1 74 969 822 147 826 792 34 114-114 77 72 5 53 52 1 37 33 4 280 58 222 99 41 58 225 19 206 571 443 128 455 387 68 104 1 103 398 270 128 204 177 27 134 13 121 13 4 9 9-9 6-6 91 84 7 76 48 28 6-6 223 223-223 223 - - - - ( ) 2001 5 2002 6 17
40. 3., 2 3-18 ( :, ) 1,539 590 949 1,304,258 1,107,036 197,222 2,616 748 1,868 1,196,035 622,491 573,544 4,155 1,338 2,817 2,500,293 1,729,527 770,766 257 98 158 217,376 184,506 32,870 238 68 170 108,730 56,590 52,140 244 79 166 147,076 101,737 45,339 ( ) 2001 5 2002 6 17 2.2 1) 2002 7 2001 5 2 3 2001 7 1 30 2001 5 20, 2001 7 17, 2002 7 16 1.
3 41 3-19 ( :, %) `0 1. 5 `0 1. 7 `02. 7 5 55.6 5 55.6 5 55.6 4 66.7 3 50.0 2 33.3 11 73.3 9 60.0 9 60.0 20 66.7 17 56.7 16 53.3 2). ( 01 5 95.0%, 01 7 82.4%, 02 7 93.8%).,,, (,, ) 2001, 2002. 2001, 2002.
42. 2002 2001 3-20 ( : %) `0 1. 5 `0 1. 7 `02. 7 (, ). 100.0-90.9 9.1 100.0-84.2 15.8 100.0-69.2 30.8 89.5 10.5 62.7 27.3 76.9 23.1 ( ) 47.4 52.6 36.4 63.6 23.1 76.9 57.9 42.1 45.5 54.5 38.5 61.5 100.0-90.9 9.1 92.3 7.7 73.7 26.3 72.7 27.3 76.9 23.1 52.6 47.4 18.2 81.8 46.1 53.9 (,,, ) 42.1 57.9 63.6 36.4 38.4 61.6 ( ) 47.9 42.1 63.6 36.4 30.8 69.2 68.4 31.6 36.4 63.6 25.0 75.0 ( ),,,. (29.6%),
3 43 (24.1%), (24.1%) 3 (70% ) 52.2% 21.8%. / 65.2% 47.8%. 34.7% 56.5% 3-21 ( : %) ( ) ( ), 78.3 21.7 74.0 26.0 52.2 47.8 40.9 59.1 52.2 47.8 21.8 78.2 34.7 65.3 56.5 43.5 34.7 65.3 21.7 78.3 / 65.2 34.8 47.8 52.2 73.9 26.1 73.9 26.1
44. 2001 3-22 ( ) 50%( ) 50%(, ) 30%(, ) 30% 40% 15 30%. ( )...,
3 45., 3)..,,,,
46.. (Hospital Fee) (Physician Fee)..., -,,,,, 1
3 47 3. 3. 1 2001 5 2002 6. 30 17 57%. 6 1. 35%. 10.8 2 3 17 96, 201 297. 6, 12, 18 2001 5 2002 6 14 17 25 1.8. 700, 300, 1,000 0.69% 70% 60% ( ),
48 60% 3.2......,, ( )..
3 49. 3.3.,....,,. 32 3..
50 4 1. 1. 1,,,
4 51 4-1 1.2 2001 5 2002 5 10 47,420-10 9 1,
52 1.3. DRG(Dignosis Related Group). DRG DRG DRG ADRG(Adjusted DRG) RDRG(Refined DRG), ADRG DRG, RDRG ADRG 1.4 DRG DRG, 1 2. 2. 1 10,,,, 12.7. 19.4
4 53,,,,. 4-1 ( :,, ) * 2,305 13.7 1,121,589 1,229,705 9,771 12.7 928,358 1,115,217 ** 8,926 17.8 886,622 984,209 6 5.5 843,400 16 19.3 2,116,554 28 8.3 844,189 8,081 16.6 1,364,032 1,518,843 9,915 15.5 1,273,425 1,511,931 117 3.8 262,427 8,255 19.4 692,533 795,754 47,420 16.1 1,033,933 1,192,513 * **, 5.1.,,.
54 4-2 ( :,, ) 17,112 13.6 983,166 883 15.7 1,071,792 4,985 30.9 747,955 3,096 12.2 1,109,297 5,948 24.2 1,839,304 3,539 20.1 1,529,449 418 16.6 1,427,006 1 49.0 3,454,150 70 29.2 1,520,927 1,591 6.4 390,271 4,341 6.4 398,222 1,570 5.1 498,780 1,360 7.2 705,388 276 10.2 298,776 793 14.2 1,020,125 5 67.8 126,582 244 39.3 2,280,704 298 11.0 733,235 550 22.5 1,956,433 7.1,. 4-3 ( :, ) * 7.1 838,855 1,032,884 15.9 1,073,342 1,244,799 ** 17.8 885,888 983,830 16.1 1,033,933 1,192,513 * **
4 55,,,, 4-4 ( : ),,,, 74 9.0% 14,568 38.9% 2,470 27.9% 17,112 36.3% 3 0.4% 880 2.4% 0.0% 883 1.9% 12 1.5% 3,342 8.9% 1,631 18.5% 4,985 10.6% 57 7.0% 2,804 7.5% 235 2.7% 3,096 6.6% 100 12.2% 5,014 13.4% 834 9.4% 5,948 12.6% 153 18.7% 2,624 7.0% 762 8.6% 3,539 7.5% 1 0.1% 417 1.1% 0.0% 418 0.9% 0.0% 1 0.0% 0.0% 1 0.0% 2 0.2% 68 0.2% 0.0% 70 0.1% 5 0.6% 1,440 3.8% 146 1.7% 1,591 3.4% 214 26.1% 1,989 5.3% 2,138 24.2% 4,341 9.2% 4 0.5% 1,355 3.6% 211 2.4% 1,570 3.3% 192 23.4% 1,013 2.7% 155 1.8% 1,360 2.9% 0.0% 160 0.4% 116 1.3% 276 0.6% 3 0.4% 658 1.8% 132 1.5% 793 1.7% 0.0% 0.0% 5 0.1% 5 0.0% 0.0% 244 0.7% 0.0% 244 0.5% 0.0% 295 0.8% 3 0.0% 298 0.6% 0.0% 550 1.5% 0.0% 550 1.2% 820 100.0% 37,422 100.0% 8,838 100.0% 47,080 100.0%
56 2.2 56.9%.., 60 70 16.5%, 16.5%. 10, 20, 80., 55.0%, 34.7%. 4-5 ( :, ),,,, 439 53.3% 21,043 55.9% 5,489 61.5% 26,971 56.9% 385 46.7% 16,615 44.1% 3,436 38.5% 20,436 43.1% 824 100.0% 37,658 100.0% 8,925 100.0% 47,407 100.0% -9 260 31.2% 2,231 5.9% 2,138 24.0% 4,629 9.8% - 19 67 8.0% 1,129 3.0% 304 3.4% 1,500 3.2% -29 83 10.0% 2,611 6.9% 429 4.8% 3,123 6.6% -39 91 10.9% 3,825 10.2% 1,025 11.5% 4,941 10.4% -49 104 12.5% 5,860 15.6% 1,528 17.1% 7,492 15.8% -59 79 9.5% 5,489 14.6% 947 10.6% 6,515 13.7% -69 78 9.4% 6,643 17.6% 1,114 12.5% 7,835 16.5% - 79 59 7.1% 6,845 18.2% 898 10.1% 7,802 16.5% 80-13 1.6% 3,027 8.0% 543 6.1% 3,583 7.6% 834 100.0% 37,660 100.0% 8,926 100.0% 47,420 100.0% 682 81.8% 20,122 53.4% 5,275 59.1% 26,079 55.0% 100 12.0% 13,036 34.6% 3,327 37.3% 16,463 34.7% 9 1.1% 301 0.8% 50 0.6% 360 0.8% 24 2.9% 1,346 3.6% 250 2.8% 1,620 3.4% 19 2.3% 2,855 7.6% 24 0.3% 2,898 6.1% 834 100.0% 37,660 100.0% 8,926 100.0% 47,420 100.0%
4 57 3. 3. 1 DRG 1) ADRG DRG. ADRG ADRG, ADRG 59 (Tonsilectomy &/ or Adenoidectomy). ADRG 214 (Back & Neck Procedures) 4-6 ADRG ( : ) ADRG 6 4 17 21 14 5 949 258 1,212 18 1 163 113 277 20 7 241 221 469 24 11 173 23 207 40 1 27 15 43 53 31 220 10 261 55 8 83 4 95 56 8 4 12 57 2 37 39 59 65 50 2 117 61 13 20 7 40 65 4 227 32 263 66 2 10 12 67 1 9 7 17 68 26 491 170 687 71 4 5 4 13 72 1 1 2 73 2 57 9 68 79 3 629 235 867
58 ADRG 82 1 290 76 367 88 6 901 205 1,112 89 24 711 360 1,095 94 1 71 19 91 96 5 511 224 740 99 1 25 26 121 1 163 6 170 127 1 462 53 516 134 1 425 54 480 144 1 59 7 67 157 1 78 13 92 159 1 6 7 161 1 41 3 45 164 1 56 2 59 166 3 167 13 183 168 1 3 3 7 172 4 522 114 640 174 2 317 40 359 176 1 30 2 33 177 3 392 31 426 179 1 13 2 16 180 5 147 12 164 182 37 1,091 229 1,357 185 2 120 37 159 188 6 556 60 622 202 10 1,284 411 1,705 203 1 384 77 462 204 2 236 28 266 205 6 478 162 646 207 1 169 13 183 209 1 80 81 214 45 67 112 223 7 58 1 66 226 4 183 18 205 229 1 4 5 231 1 54 2 57 243 10 496 62 568 253 1 70 24 95
4 59 ADRG 257 6 9 15 261 8 13 1 22 262 4 19 3 26 269 5 251 31 287 272 1 30 11 42 274 2 35 8 45 276 1 9 4 14 277 1 102 30 133 280 1 381 82 464 283 1 158 47 206 290 2 63 65 294 1 643 132 776 296 7 95 1 103 299 1 17 4 22 308 1 32 33 320 2 172 21 195 331 5 443 92 540 339 1 30 4 35 356 1 47 48 378 3 37 7 47 384 1 264 4 269 391 3 173 163 339 394 1 7 1 9 395 1 74 3 78 415 1 36 3 40 419 2 82 4 88 421 4 114 16 134 423 7 270 32 309 429 3 121 61 185 430 10 887 640 1,537 434 1 498 834 1,333 444 2 24 5 31 452 2 34 36 468 3 268 59 330 469 1 25 1 27 496 19,596 5,777 25,869
60 ADRG 10 ADRG. 11 ADRG 282. 5,490 1,914,. 4-7 ADRG (10 ) ( : ) ADRG 24(viral meningitis) 3.0 10.9 6.3 10.0 53(sinus) 5.4 9.7 4.4 9.0 59(tosillectomy) 3.8 6.8 5.0 5.1 61(myringotomy) 2.4 4.2 3.0 3.4 68(ottitis media) 5.5 5.6 5.5 5.5 89(pneumonia) 6.7 9.1 8.5 8.9 182(esophasitis) 4.2 6.5 7.5 6.6 202(cirrhosis) 8.0 14.7 16.2 15.0 214(back&neck proc) 5.4 19.6 13.9 243(medical back prob) 17.9 15.9 16.1 16.0 430(psychoses) 21.1 33.1 35.3 33.9 ADRG 1., ADRG 202 1
4 61 4-8 ADRG ADRG (10 ) ( : ) * ** 24 200,853 454,490 650,784 1,288,720 397,849 771,849 598,771 1,186,958 53 927,708 1,843,825 1,542,236 2,246,974 982,784 1,578,679 1,447,811 2,173,485 59 530,026 655,359 593,489 814,560 567,330 604,470 557,785 722,524 61 441,288 720,755 621,790 1,036,725 354,420 489,060 516,337 838,194 68 307,750 476,966 387,609 716,692 361,999 595,266 378,249 677,572 89 445,465 775,895 759,262 1,304,452 530,611 786,139 677,211 1,122,463 182 279,115 534,692 495,272 963,861 419,600 711,316 476,608 909,541 202 596,687 1,989,247 1,065,659 1,744,312 772,090 1,305,955 992,142 1,640,080 214 2,633,599 3,925,929 3,299,936 4,427,135 3,032,211 4,225,758 243 671,964 1,034,775 804,744 1,390,644 627,132 1,038,720 783,019 1,345,964 430 695,158 986,766 817,510 1,402,890 1,094,991 1,862,028 932,255 1,591,366 * **, 1 2) ADRG,.. 4 7 ADRG 78 252.,. ADRG ADRG 214
62 4-9 ADRG (4 ) ( : ) ADRG 6(carpal tunnel syn) 4 6 10 214(back&neck proc) 45 28 73 223(major extrem proc) 7 7 14 226(soft tissue proc) 4 72 76 243(medical back prob) 9 121 130 261(breast proc for non-malig) 5 8 13 262(breast biopsy) 4 10 14 78 252 330. ADRG 243 4-10 ADRG (4 ) ( : ) ADRG 6(carpal tunnel syn) 2.0 10.8 7.3 214(back&neck proc) 5.4 17.9 10.2 223(major extrem proc) 2.0 12.4 7.2 226(soft tissue proc) 2.0 9.8 9.4 243(medical back prob) 18.7 17.0 17.1 261(breast proc for non-malig) 2.2 6.9 5.1 262(breast biopsy) 2.3 3.6 3.2. 1
4 63 4-11 ADRG (4 ) ADRG ( : ) * ** 6 430,308 996,760 1,054,945 1,677,625 805,090 1,405,279 214 2,633,599 3,925,929 3,272,424 4,758,185 2,878,628 4,245,150 223 535,060 1,449,140 1,516,834 1,732,823 1,025,947 1,590,981 226 386,825 1,159,935 1,028,891 1,470,023 995,098 1,453,702 243 681,379 846,908 771,341 1,350,279 765,113 1,315,430 261 575,666 814,504 845,613 1,185,319 741,787 1,042,698 262 378,958 528,893 401,209 629,044 394,851 600,429 * **, 1 3) RDRG ADRG,, ADRG. RDRG RDRG RDRG. RDRG 10 RDRG 9 RDRG 10, RDRG 059010( 17, 0 ). RDRG 061010( 17, 0 ) 2.3
64 4-12 RDRG (10 ) ( :, ) RDRG 053000 24 5.6 195 9.4 219 8.9 059000 17 3.7 26 8.0 43 6.3 059010 45 3.6 24 5.5 69 4.3 061010 12 2.3 12 2.6 24 2.4 068000 19 6.1 369 5.0 388 5.0 182000 10 6.6 584 5.8 594 5.8 182011 19 3.1 18 5.7 37 4.4 214000 33 4.5 50 19.5 83 13.5 214001 12 8.1 15 20.2 27 14.8 191 4.6 1,293 6.8 1,484 6.5, 6 RDRG, 3 RDRG. 1 ADRG, ADRG, RDRG. RDRG 4-13 RDRG (10 ) ( : ) RDRG * ** 053000 954,275 2,005,925 1,530,094 2,191,408 1,466,990 2,171,081 059000 496,251 720,785 591,123 840,577 553,615 793,217 059010 535,754 630,710 596,053 786,375 556,728 684,854 061010 380,963 555,199 330,661 469,447 355,812 512,323 068000 320,521 460,505 345,390 695,445 344,172 683,940 182000 504,193 1,111,826 447,902 896,553 448,850 900,177 182011 177,962 281,953 323,117 418,962 248,578 348,606 214000 1,921,306 2,938,637 3,108,588 3,951,333 2,636,536 3,548,695 214001 4,592,405 6,640,983 3,843,404 6,053,150 4,176,293 6,314,409 * **, 1
4 65 3.2 1) ADRG 10 11 ADRG, 282 85,303. 26.4% ADRG ADRG 214. 4-14 ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 24 11 650,784 200,853 7,158,626 2,209,380 4,949,246 53 31 1,542,236 927,708 47,809,317 28,758,960 19,050,357 59 65 593,489 530,026 38,576,811 34,451,690 4,125,121 61 13 621,790 441,288 8,083,270 5,736,750 2,346,520 68 26 387,609 307,750 10,077,829 8,001,490 2,076,339 89 24 759,262 445,465 18,222,283 10,691,160 7,531,123 182 37 495,272 279,115 18,325,063 10,327,270 7,997,793 202 10 1,065,659 596,687 10,656,592 5,966,870 4,689,722 214 45 3,299,936 2,633,599 148,497,112 118,511,950 29,985,162 243 10 804,744 671,964 8,047,440 6,719,640 1,327,800 430 10 817,510 695,158 8,175,095 6,951,580 1,223,515 282 323,629,438 238,326,740 85,302,698 1 98,752. 20.6%
66 4-15 * ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 24 11 1,288,720 454,490 14,175,915 4,999,390 9,176,525 53 31 2,246,974 1,843,825 69,656,190 57,158,570 12,497,620 59 65 814,560 655,359 52,946,400 42,598,350 10,348,050 61 13 1,036,725 720,755 13,477,425 9,369,820 4,107,605 68 26 716,692 476,966 18,633,998 12,401,110 6,232,888 89 24 1,304,452 775,895 31,306,859 18,621,470 12,685,389 182 37 963,861 534,692 35,662,862 19,783,610 15,879,252 202 10 1,744,312 1,989,247 17,443,121 19,892,470-2,449,349 214 45 4,427,135 3,925,929 199,221,085 176,666,800 22,554,285 243 10 1,390,644 1,034,775 13,906,438 10,347,750 3,558,688 430 10 1,402,890 986,766 14,028,905 9,867,660 4,161,245 282 480,459,199 381,707,000 98,752,199 *, 1, 70,890. 26.6% 4-16 ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 24 11 583,786 160,685 6,421,650 1,767,540 4,654,110 53 31 1,269,546 754,433 39,355,927 23,387,420 15,968,507 59 65 480,904 427,836 31,258,760 27,809,360 3,449,400 61 13 497,436 353,035 6,466,668 4,589,450 1,877,218 68 26 318,431 250,633 8,279,214 6,516,450 1,762,764 89 24 637,003 385,680 15,288,071 9,256,310 6,031,761 182 37 420,040 231,768 15,541,471 8,575,410 6,966,061 202 10 942,166 506,565 9,421,658 5,065,650 4,356,008 214 45 2,670,316 2,146,875 120,164,239 96,609,370 23,554,869 243 10 731,754 608,215 7,317,535 6,082,150 1,235,385 430 10 699,966 596,556 6,999,665 5,965,560 1,034,105 282 266,514,858 195,624,670 70,890,188
4 67 1 79,905. 20.7%. 4-17 * ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 24 11 1,077,044 349,254 11,847,481 3,841,799 8,005,682 53 31 1,789,068 1,455,729 55,461,098 45,127,592 10,333,506 59 65 646,397 522,489 42,015,822 33,961,777 8,054,045 61 13 802,185 562,003 10,428,400 7,306,038 3,122,362 68 26 568,408 373,376 14,778,614 9,707,774 5,070,840 89 24 1,053,376 643,899 25,281,032 15,453,586 9,827,446 182 37 778,405 427,543 28,800,996 15,819,104 12,981,892 202 10 1,465,697 1,600,101 14,656,965 16,001,010-1,344,045 214 45 3,549,667 3,162,028 159,735,020 142,291,282 17,443,738 243 10 1,182,902 877,511 11,829,016 8,775,113 3,053,903 430 10 1,153,500 817,897 11,534,999 8,178,973 3,356,026 282 386,369,443 306,464,048 79,905,395 *, 1 ADRG. 10., ADRG., RDRG 2) ADRG ADRG 4 7 ADRG
68, 78 42,935. 24.0% ADRG ADRG 214. 4-18 ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 1,054,945 430,308 4,219,780 1,721,230 2,498,550 214 45 3,272,424 2,633,599 147,259,061 118,511,950 28,747,111 223 7 1,516,834 535,060 10,617,840 3,745,420 6,872,420 226 4 1,028,891 386,825 4,115,564 1,547,300 2,568,264 243 9 771,341 681,379 6,942,067 6,132,410 809,657 261 5 845,613 575,666 4,228,063 2,878,330 1,349,733 262 4 401,209 378,958 1,604,836 1,515,830 89,006 78 178,987,211 136,052,470 42,934,741 1 50,186. 19.3% 4-19 * ( : ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 1,677,625 996,760 6,710,500 3,987,040 2,723,460 214 45 4,758,185 3,925,929 214,118,309 176,666,800 37,451,509 223 7 1,732,823 1,449,140 12,129,760 10,143,980 1,985,780 226 4 1,470,023 1,159,935 5,880,090 4,639,740 1,240,350 243 9 1,350,279 846,908 12,152,508 7,622,170 4,530,338 261 5 1,185,319 814,504 5,926,594 4,072,520 1,854,074 262 4 629,044 528,893 2,516,176 2,115,570 400,606 78 259,433,937 209,247,820 50,186,117 *, 1
4 69, 38,755. 25.8% 4-20 ( :, ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 843,960 344,250 3,375,840 1,377,000 1,998,840 214 45 2,744,911 2,146,875 123,521,014 96,609,370 26,911,644 223 7 1,244,146 428,051 8,709,020 2,996,360 5,712,660 226 4 873,744 309,465 3,494,977 1,237,860 2,257,117 243 9 692,458 623,596 6,232,118 5,612,360 619,758 261 5 690,038 460,534 3,450,188 2,302,670 1,147,518 262 4 330,064 303,173 1,320,256 1,212,690 107,566 78 150,103,412 111,348,310 38,755,102 1 44,155. 20.8% 4-21 * ( :, ) ADRG (A) (B) (C) A B(D) A C(E) (D- E) 6 4 1,329,859 767,340 5,319,436 3,069,361 2,250,075 214 45 3,907,269 3,162,028 175,827,105 142,291,282 33,535,823 223 7 1,397,615 1,141,393 9,783,302 7,989,749 1,793,553 226 4 1,208,051 919,665 4,832,205 3,678,661 1,153,544 243 9 1,140,091 734,306 10,260,822 6,608,752 3,652,070 261 5 953,797 650,368 4,768,984 3,251,840 1,517,144 262 4 480,544 417,346 1,922,175 1,669,384 252,791 78 212,714,030 168,559,029 44,155,001 *, 1
70. RDRG 3) RDRG RDRG 10 9, 191 50,402. 20.7% RDRG RDRG 214000, RDRG 214001. RDRG 053000, 059000, 059010, 068000, 182011, 214000 6, RDRG 061010, 182000, 214001 3 RDRG ADRG.. 4-22 RDRG (10 ) ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) 053000 24 1,530,094 954,275 36,722,247 22,902,610 13,819,637 059000 17 591,123 496,251 10,049,092 8,436,260 1,612,832 059010 45 596,053 535,754 26,822,381 24,108,950 2,713,431 061010 12 330,661 380,963 3,967,930 4,571,560-603,630 068000 19 345,390 320,521 6,562,408 6,089,890 472,518 182000 10 447,902 504,193 4,479,021 5,041,930-562,909 182011 19 323,117 177,962 6,139,227 3,381,280 2,757,947 214000 33 3,108,588 1,921,306 102,583,404 63,403,090 39,180,314 214001 12 3,843,404 4,592,405 46,120,848 55,108,860-8,988,012 191 243,446,559 193,044,430 50,402,129 1 43,743. 12.8%
4 71 4-23 RDRG * (10 ) ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) 053000 24 2,191,408 2,005,925 52,593,791 48,142,200 4,451,591 059000 17 840,577 720,785 14,289,808 12,253,350 2,036,458 059010 45 786,375 630,710 35,386,875 28,381,950 7,004,925 061010 12 469,447 555,199 5,633,360 6,662,390-1,029,030 068000 19 695,445 460,505 13,213,454 8,749,600 4,463,854 182000 10 896,553 1,111,826 8,965,525 11,118,260-2,152,735 182011 19 418,962 281,953 7,960,272 5,357,110 2,603,162 214000 33 3,951,333 2,938,637 130,393,996 96,975,010 33,418,986 214001 12 6,053,150 6,640,983 72,637,800 79,691,790-7,053,990 191 341,074,880 297,331,660 43,743,220 *, 1, 40,632. 20.6% 4-24 RDRG ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) 053000 24 1,255,470 767,273 30,131,278 18,414,540 11,716,738 059000 17 477,356 397,005 8,115,048 6,749,080 1,365,968 059010 45 484,748 434,113 21,813,656 19,535,080 2,278,576 061010 12 264,532 304,774 3,174,380 3,657,290-482,910 068000 19 280,466 262,481 5,328,854 4,987,140 341,714 182000 10 377,579 434,704 3,775,789 4,347,040-571,251 182011 19 270,489 142,374 5,139,299 2,705,100 2,434,199 214000 33 2,488,517 1,580,158 82,121,074 52,145,210 29,975,864 214001 12 3,169,785 3,705,347 38,037,416 44,464,160-6,426,744 191 197,636,795 157,004,640 40,632,155
72 1 34,328. 12.6% 4-25 RDRG * ( :, ) RDRG (A) (B) (C) A B(D) A C(E) (D- E) 053000 24 1,738,796 1,575,001 41,731,094 37,800,025 3,931,069 059000 17 669,256 564,427 11,377,355 9,595,254 1,782,101 059010 45 621,633 506,705 27,973,506 22,801,723 5,171,783 061010 12 364,600 434,671 4,375,196 5,216,047-840,851 068000 19 546,475 360,143 10,383,027 6,842,719 3,540,308 182000 10 719,387 896,802 7,193,874 8,968,019-1,774,145 182011 19 339,634 224,673 6,453,047 4,268,790 2,184,257 214000 33 3,139,062 2,372,960 103,589,052 78,307,675 25,281,377 214001 12 4,919,669 5,331,967 59,036,032 63,983,607-4,947,575 191 272,112,183 237,783,859 34,328,324 *, 1 4. 4. 1 ADRG ADRG (ratio) 1.26 3.24 1.
4 73 4-26 ADRG (10 ) ( : ) ADRG / 24 200,853 650,784 623,886 3.24 53 927,708 1,542,236 1,466,338 1.66 59 530,026 593,489 557,619 1.12 61 441,288 621,790 550,683 1.41 68 307,750 387,609 383,593 1.26 89 445,465 759,262 749,015 1.70 182 279,115 495,272 488,182 1.77 202 596,687 1,065,659 1,062,035 1.79 214 2,633,599 3,299,936 3,032,211 1.25 243 671,964 804,744 802,120 1.20 430 695,158 817,510 816,146 1.18., ADRG (ratio) (ratio). ADRG 430 1. 4-27 ADRG (10 ) ( : ) ADRG / 24 28,268 165,682 157,467 5.86 53 136,105 495,151 450,807 3.64 59 60,489 152,187 100,358 2.52 61 35,170 186,778 127,053 5.31 68 90,613 158,573 155,155 1.75 89 110,934 286,036 280,318 2.58 182 77,473 148,977 146,631 1.92 202 146,061 317,276 315,953 2.17 214 183,387 661,598 469,460 3.61 243 110,169 168,064 166,919 1.53 430 119,692 59,264 59,938 0.50
74 4-28 ADRG (10 ) ADRG 24 14.1% 25.5% 25.2% 53 14.7% 32.1% 30.7% 59 11.4% 25.6% 18.0% 61 8.0% 30.0% 23.1% 68 29.4% 40.9% 40.4% 89 24.9% 37.7% 37.4% 182 27.8% 30.1% 30.0% 202 24.5% 29.8% 29.7% 214 7.0% 20.0% 15.5% 243 16.4% 20.9% 20.8% 430 17.2% 7.2% 7.3% * = /, (ratio) ADRG (ratio) (ratio). ADRG 243 1..
4 75 4-29 ADRG (10 ) ( : ) ADRG / 24 83,841 274,871 263,451 3.28 53 103,306 196,035 184,582 1.90 59 73,585 103,928 86,778 1.41 61 44,798 79,567 65,870 1.78 68 98,024 116,022 115,117 1.18 89 159,008 242,187 239,471 1.52 182 107,382 156,292 154,687 1.46 202 203,123 391,400 389,945 1.93 214 95,071 404,616 280,245 4.26 243 353,350 321,780 322,404 0.91 430 426,198 573,240 571,600 1.35 4-30 ADRG (10 ) ADRG 24 41.7% 42.2% 42.2% 53 11.1% 12.7% 12.6% 59 13.9% 17.5% 15.6% 61 10.2% 12.8% 12.0% 68 31.9% 29.9% 30.0% 89 35.7% 31.9% 32.0% 182 38.5% 31.6% 31.7% 202 34.0% 36.7% 36.7% 214 3.6% 12.3% 9.2% 243 52.6% 40.0% 40.2% 430 61.3% 70.1% 70.0% * = /
76 (ratio) (ratio) (ratio) 4-31 ADRG (10 ) ( : ) ADRG / 24 7,395 55,141 52,287 7.46 53 40,583 103,793 95,986 2.56 59 20,767 26,771 23,377 1.29 61 13,314 54,915 38,527 4.12 68 13,606 37,921 36,698 2.79 89 21,274 47,435 46,581 2.23 182 10,538 35,519 34,700 3.37 202 27,418 74,771 74,405 2.73 214 14,492 97,605 64,212 6.73 243 67,053 79,420 79,176 1.18 430 87,335 52,930 53,313 0.61 4-32 ADRG (10 ) ADRG 24 3.7% 8.5% 8.4% 53 4.4% 6.7% 6.5% 59 3.9% 4.5% 4.2% 61 3.0% 8.8% 7.0% 68 4.4% 9.8% 9.6% 89 4.8% 6.2% 6.2% 182 3.8% 7.2% 7.1% 202 4.6% 7.0% 7.0% 214 0.6% 3.0% 2.1% 243 10.0% 9.9% 9.9% 430 12.6% 6.5% 6.5% * = /
4 77 ADRG (ratio) (ratio) (ratio) 4-33 ADRG (10 ) ( : ) ADRG / 24 40,492 147,049 140,679 3.63 53 134,610 458,192 418,227 3.40 59 61,214 156,820 102,782 2.56 61 32,605 159,002 109,209 4.88 68 106,493 149,135 146,990 1.40 89 127,062 286,733 281,519 2.26 182 89,888 145,079 143,269 1.61 202 152,465 296,219 295,108 1.94 214 205,368 659,298 476,915 3.21 243 84,364 133,471 132,500 1.58 430 62,253 14,478 15,010 0.23 4-34 ADRG (10 ) ADRG 24 20.2% 22.6% 22.5% 53 14.5% 29.7% 28.5% 59 11.5% 26.4% 18.4% 61 7.4% 25.6% 19.8% 68 34.6% 38.5% 38.3% 89 28.5% 37.8% 37.6% 182 32.2% 29.3% 29.3% 202 25.6% 27.8% 27.8% 214 7.8% 20.0% 15.7% 243 12.6% 16.6% 16.5% 430 9.0% 1.8% 1.8% * = /
78,,. (ratio). 4-35 ADRG,, (10 ) ( : ) ADRG / 24 48,126 116,678 112,580 2.42 53 426,525 487,909 480,328 1.14 59 220,125 159,854 193,921 0.73 61 200,439 177,017 186,244 0.88 68 64,207 62,814 62,884 0.98 89 100,559 141,702 140,359 1.41 182 53,960 123,821 121,530 2.29 202 156,344 243,972 243,294 1.56 214 1,982,418 1,744,789 1,840,265 0.88 243 76,518 123,987 123,049 1.62 430 53,304 40,242 40,387 0.75,, 4-36 ADRG,, (10 ) ADRG 24 24.0% 17.9% 18.0% 53 46.0% 31.6% 32.8% 59 41.5% 26.9% 34.8% 61 45.4% 28.5% 33.8% 68 20.9% 16.2% 16.4% 89 22.6% 18.7% 18.7% 182 19.3% 25.0% 24.9% 202 26.2% 22.9% 22.9% 214 75.3% 52.9% 60.7% 243 11.4% 15.4% 15.3% 430 7.7% 4.9% 4.9% * = /
4 79,,,,., 4.2 10,,,,,,, 7. 4.3. 26.3. 4-37 (10 ) ( :, ) 74 6.3 14,568 13.0 14,642 12.9 12 26.3 3,342 30.4 3,354 30.4 57 9.8 2,804 12.1 2,861 12.0 100 9.5 5,014 24.5 5,114 24.2 153 8.9 2,624 19.9 2,777 19.3 214 4.3 1,989 5.7 2,203 5.5 192 5.4 1,013 7.8 1,205 7.4 802 7.0 31,354 16.5 32,156 16.3 (ratio) 5 1, 2 1. 1.30
80 4-38 (10 ) ( : ) / 456,824 975,124 972,505 2.13 732,183 599,138 599,614 0.82 1,046,780 1,108,657 1,107,424 1.06 1,152,082 1,953,645 1,937,971 1.70 1,997,521 1,646,252 1,665,605 0.82 264,395 349,519 341,250 1.32 549,178 770,819 735,503 1.40 854,251 1,113,350 1,106,888 1.30 (ratio) (ratio) 4-39 (10 ) ( : ) / 119,690 305,250 304,312 2.55 111,131 32,835 33,115 0.30 241,026 371,991 369,381 1.54 134,902 485,383 478,529 3.60 199,690 478,245 462,898 2.39 55,831 90,107 86,778 1.61 75,451 297,009 261,706 3.94 117,714 311,552 306,717 2.65 (ratio) (ratio)
4 81 4-40 (10 ) ( : ) / 160,973 330,345 329,489 2.05 476,818 446,048 446,158 0.94 197,216 229,978 229,325 1.17 173,564 471,805 465,974 2.72 168,199 491,455 473,645 2.92 110,965 141,344 138,393 1.27 70,306 132,494 122,585 1.88 136,174 351,425 346,056 2.58 (ratio) (ratio) 4-41 (10 ) ( : ) / 19,705 68,473 68,227 3.47 100,894 26,339 26,606 0.26 44,518 50,066 49,956 1.12 22,236 108,011 106,334 4.86 32,388 105,885 101,835 3.27 7,437 18,116 17,078 2.44 25,683 63,199 57,221 2.46 23,576 68,425 67,306 2.90 (ratio) (ratio)
82 4-42 (10 ) ( : ) / 126,891 287,421 286,609 2.27 27,113 12,604 12,656 0.46 230,729 380,530 377,546 1.65 137,601 449,846 443,740 3.27 205,430 446,198 432,933 2.17 78,270 101,360 99,117 1.30 72,337 275,641 243,247 3.81 123,063 293,534 289,282 2.39 (ratio). 4-43,, (10 ) ( : ) / 103,682 228,113 227,485 2.20 52,950 26,819 26,913 0.51 370,805 305,660 306,958 0.82 618,600 736,636 734,327 1.19 1,354,913 423,828 475,126 0.31 48,281 66,109 64,377 1.37 237,796 183,701 192,320 0.77 442,138 299,581 303,136 0.68,,,,.
4 83 4.3, 4-44 ( :, ) 682 5.2 20,122 12.0 20,804 11.7 100 19.8 13,036 22.1 13,136 22.1 782 7.1 33,158 16.0 33,940 15.8, (ratio) 1 1. 4-45 ( : ) / 799,068 1,056,688 1,048,243 1.32 1,209,341 1,177,331 1,177,575 0.97 851,533 1,104,119 1,098,299 1.30 1., 4-46 ( : ) / 105,683 313,276 306,470 2.96 217,469 315,704 314,956 1.45 119,978 314,230 309,755 2.62
84 1, 4-47 ( : ) / 112,673 296,785 290,749 2.63 315,759 413,280 412,537 1.31 138,643 342,584 337,885 2.47 1, 4-48 ( : ) / 18,852 64,680 63,177 3.43 62,127 77,698 77,580 1.25 24,386 69,798 68,751 2.86 1. 4-49 ( : ) / 114,218 299,239 293,174 2.62 199,219 287,592 286,919 1.44 125,088 294,660 290,753 2.36,,, 1
4 85 4-50 ( : ) / 360,682 161,639 168,164 0.45 431,354 208,935 210,629 0.48 369,719 180,233 184,599 0.49 1, 4-51 ( : ) / 55,745 106,218 104,563 1.91 50,059 90,667 90,357 1.81 55,018 100,104 99,065 1.82 1, 1 4-52 ( : ) / 12,261 20,293 20,030 1.66 20,178 16,440 16,469 0.81 13,274 18,778 18,651 1.41
86 4.4 (, ) 1).. ( ) 4-53, (B1) (4.2 ) (B2) (B3) (4.2 ) (WTP) (B4) (B1 B2) 4.2 20.6%(ADRG ) 12.8%(RDRG ) (B3). (B4).
4 87 2),,. 6) ( 1. ) 4-54 1 (7.7) 9 (69.2) 3 (23.1) ( ) - 2 (8.7) ( ) 15 (65.2) 5 (21.7) 1 (4.3) 4 (17.4) 13 (56.5) 4 (17.4) 2 (8.7) 4.5, 10 47,420, DRG(Diagnosis Related Group) 12.7 6)
88, 19.4. 7.1,.,,,, 60 70, ADRG ADRG 59 (Tonsilectomy &/ or Adenoidectomy). 10 ADRG RDRG, 6 RDRG, 3 RDRG. RDRG, 26.4%, 1 20.6%. RDRG 20.7%, 1 12.8%,,,,,.,,,,..,
4 89. episode.. DRG. DRG,. KADRG KARDRG. DRG.
90 5 1. 1. 1 1).. 1965. 1980 1984 7 ( ). ( ) ( )
5 91 1986 1 ( ) 1986 4 ( ),,. 1998 3 ( ) 2) 1999 8,200 333 4.1%,,, (21.8%)
92 5-1 ( ) ( :, %) (A) (B) (B A) 8,222 225 67 838 50 333 4.1 100.0 - - - - - 366 225 141 1,314 267 753 294 87 84 3 46 31 6 9 4 4-14 5 5 4 131 2 3 2-8 6.1 2.4 330 5 7 22 2 72 21.8 21.6 4,494 14 26 663 41 112 2.5 33.6 359 69 13 24 1 10 2.8 3.0 68 - - - - 2 2.9 0.6 1,160 2-123 1 14 1.2 4.2 : 11 (99 ),, 99 11 1 - - - 4-2 2 2 2-3 - 2 1 21 15 6 94 12 48 34 5.7 6.7 4.3 7.2 4.5 6.4 11.6 100 399 68.5%. 300 699 10% 6.3 4.5 1.8 28.2 3.6 14.4 10.2
5 93 5-2 ( ) ( :, %) (A) (B) (B A) 8,222 333 4.1 100.0 20 49 1,397 10 0.7 3.0 50 99 2,383 30 1.3 9.0 100 149 1,297 39 3.0 11.7 150 199 922 51 5.5 15.3 200 299 912 74 8.1 22.2 300 399 578 64 11.1 19.2 400 499 279 28 10.0 8.4 500 599 169 17 10.1 5.1 600 699 122 14 11.5 4.2 700 799 58 3 5.2 0.9 800 899 33 - - - 900 72 3 4.2 0.9 : 11 (99 ),, 99 11 1 1.2 1). 1987 70 1986 6 1 300. ( ) 1 250, 150. (I)170 (II)400. 6 1
94 2) ( ).. 35,,,..,.
5 95 5-3 (2000 4 1 ) ( :,, %) 1999 1999 57 20 40.2 1998 69 5 100.0 1991 117 30 20.8 1995 155 20 40.6 1986 396 50 100.7 1999 45 20 74.1 1996 98 5 48.0 1997 44 15 44.6 1992 155 17 35.3 1996 39 25 58.0 1997 56 20 35.4 1993 29 20 3.9 1986 83 50 94.4 1990 289 30 4.0 1996 614 110 97.4 1993 34 30 0.0 ) 2000 19 20 23.8 17 2,299 487 ( ) 2000 30 3).
96 1.3 1) (1994 61, 1998 35 ). ( ),. 2 ( ) 20 ( ). 50% 5 30 - -
5 97-20%.,. = (30 ) 30 ). ( ) 2 5 30 (4) ( ) ( 2 6 ) ( ) (2) (5)
98 2 5 : 1. ( ) 2. ( 30 ) ( )% ( ) [( ) 30 ] 3. (1) (2) ( ) ( ) ( ) ( ) ( ) 1 ( ) 1. ( ) 2. (3) : ( ) ( ) ( )
5 99 2 6 : [ ] 1. 2 2. 30,
100 2) ( )., ( ), 1 1. 2002 1 1 350, 330, 1 1 220 430 1.4.. 1) 1998 5 3 2002 5 41 2),,, ( 30 3) 3)
5 101 4) (2001 19 ) 1.5 -, - ( ( ) ) ( ) ( ) - (,, ), (Refer) - - (1996 6 ) - 3 1 (1998 ), - 3 (2005 ), 2. 2. 1.
102 (Admitting Privilege) (Community Hospital), 2.2 1) 1847 (American Medical Association, AMA) (Medical Ethics) 7) 19 (AMA) (fee-for- service),. 7) Principles of Medical Ethics VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care
5 103, (fee-for- service) (AMA).,. (Medical Staff Organization, MSO) 2) 19. 19 20 1920. ( ),,
104 2.3 1) ( ) CEO (MSO) 5-1 8) 8) Rakich J S, Longest Jr. B B, Darr K. Managing Health Services Organizations, Third Edition. Health Professions Press. 1992. p224
5 105 2). (MSO)..,,,, (MSO).,, (hospital-based private practice), (professional office building) 3). 9) (Credentials Committee) (MSO) 9)
106. ( ) 5-2, (privilege)..
5 107 1 2 (medical staff credentials committee). (scheduling), 4) - Active medical staff : - Associated medical staff : Active medical staff 1-2 - Consulting medical staff : - Courtesy medical staff : - Consulting medical staff : - House medical staff : Attending Physician. House medical staff, Attending Physician 2.4 (physician services) (non-physician services).
108,. (Medicare) (Medicaid), (BlueCross BlueSheld) (Private Insurance Company) 3 (third party payer). (physician fee schedule), (capital).,,,,, ( ), (attending physician ). (physician office). (Prospective Payment System, PPS),, (physician fee schedule), PPS (Diagnosis-Related Group, DRG) PPS (Ambulatory Payment Classifications, APC) Medicare Part A Part B. Part A Hospital Insurance, Part B Medical Insurance PPS (operating and capital-related costs) (rates). (DRG). DRG (relative weight), DRG (physician fee)
5 109 PPS 1997 (Balanced Budget Act) (cost-based payment) DRG PPS. (APC) 2000 8. DRG APC DRG (diagnoses), APC (procedures) PPS APC (451 ). APC,. APC APC (relative weight) (, operating and capital ), (conversion factor). DRG. DRG DRG, APC APC (physician fee schedule) Medicare CPR(Customary, Prevailing, Resonable charges) (RBRVS, Resource-based Relative Value Scale) 1992 1 time, training, skill. (physician work), (practice expenses) (professional liability insurance), (technical skill), (mental effort, physical effort), (judgement), (stress),,,, (malpractice) (hospital-based physicians). (resonable cost basis). (professional
110 component) (hospital component).,. (,,, ) 2.5 1) 80..... (DRG, APC),,. 10) 10)
5 111... (Man aged Car e) 80 HMO(Health Maintenance Organization) 90 70%. 80% (Capitation),,..,. (doctors workshops).
112 11) ( ). 20, 12).. 2),.., 11), 12)
5 113. (In tegr ated Delivery Syst em, IDS) (Mu lti-h ospit al Ch ain ). ( ) 3 (IDS) (Multi-Hospital Chain). ( )
114 5-3 13). (Hospitalist ) (Hospitalist) 1990 25% 13) Longest Jr. B B, Rakich J S, Darr K. Managing Health Services Organizations and Systems, Fourth Edition. Health Professions Press. 2001. p176
5 115 (hand- off) ( 25% ). 25% 12% -,,,,, -,,, QI,,
116 5-4 1 2 3 (hospitallist) 4. ( ),, ( ) 3 3 2 1 3 2.6 (Physician fee) (Hospital
5 117 fee) (My Doctor) 14), 14) 1 (Primary Care Physician, PCP),, 1
118 6 1. 1. 1 1) - ( ). ( ). - (Managed Care), (Nursing Home) (Vertical Integration) IDS(Integrated Delivery System) - 4, (
6 119 1 2 3 ), ( 3 ).. 2). 4. (Resources Dependence). 70 80% 10 20%..,. 4.4 4.9 OECD
120 3.2 3.7... (Contact Point)...,.. 3 4. (Skill)
6 121. (, ) 1.2 1).,, 4 - : - : - : - :
122 6-1 (, ), (, ), ( ), ( ), ( ), (, ( ), ( ),, ), ( ( ), ( ), (, ) (10 ) ( ), ( ) ), ( ) (10 ) ( ), (, ( ), ( ), ) ( ), ( ), (3 ) ( ) (5 ) ( ) (1 ) ( ) (1 ). 46.2%, 64.7% 6-2 ( ;, %) 10 10 20 5 5 10 50.0 50.0 50.0 3 5 8 1 5 6 33.3 100.0 75.0 1 1 0.0 0.0 1 1 1 1 100.0 100.0 13 17 30 6 11 17 46.2 64.7 56.7
6 123 0.69%. 1 10.8 ( 6.5 ) ( 3 ) 6-3 ( ;,, %) ) ) ) 39 57,601 (0.08) 389 176,834 (0.43) 214 117,217 (0.25) 1,342 1,016,255 (6.12) 124 40,843 (0.20) 327 203,412 (1.39) 50 107,647 50 107,647 257 217,376 (1.29) 238 108,730 (0.31) 244 147,076 (0.69) ( ) 1. ( + ) 2. (2001 4 2002 6 ) 1 2. 2. 1 1) 1932 1997 8 1998 IMF 2).
124. - 1999 12-2000 3-2000 4-2000 5 1-2001 5 2001, -,,, 3) (Incremental). (, ) 15). 40%. 15) (Contribution Margin) =. 2001 60%. 40% (,, 2001)
6 125 6-4 ( :, %) 1997 1998 1999 2000 2001 2002 (7 ) 316 447 453 446 446 430 77.0 77.9 84.3 80.4 80.2 77.2 4).,,. -,. 10. :.. (2001 ) :..,
126...,.. 1. (Order) 2.2 1) 1907
6 127 1983 1993 12 2) 96 62.5%, 97 60%, 98 60%. 1999 4 3).,. 2..,,.. 2.
128. 2.3 1) 1966 1970 1982 1990 19 295 1994 1996 22 702 2) 3). 2002 10 5 (PM : Patient Management ). 1, 1 - (, Locker, )
6 129 - (Arrange) - Name Card, : 4).. 2.4 1) 1921 1956. 1983 7 1999 9 (20 /385 ) 2001 4 2). 2002 10 20 4 5
130. 5 ( ), 6-5 ( :, %) 32 5,,,, ( ),,, 20 4,,, 31 6,,,,,, 30 8,,,,, 30 7,,,,, - OCS, EDI, PACS (Medios- ) PACS
6 131 -. 2.5 1) ( ) - (Order) - - - 2). ERG (1972)
132 (Clayton Alderfer) ERG,, 3 - (Existence) : - (Relatedness) : - (Growth) : need for self- esteem and self- actualization (Regression).. A - - - B..
6 133 6-1 ( ). ( ) 3)..
134... -, -, -., - 3. 3. 1 1) 100 19.5 12.1 ( 15.0, 25.5 ) 13.1 15.5
6 135 6-6 (A) (B) (B/ A*100) ) ( :, %) 19.5 12.1 161.9 25.5 15.0 15.5 13.1 41.7-100.0 61.8 130.7 76.5 79.1 67.2 213.4 9.7 8.4 115.6 10.9 8.7 8.2 8.2 15.6-100.0 86.5 112.7 90.3 85.1 84.4 161.5 0.3 0.4 65.9 0.3 0.2 0.4 0.2 0.2 7.3 2.5 288.8 11.1 4.4 4.4 3.6 20.9 2.1 0.8 262.3 3.2 1.2 1.7 1.1 5.0 0.3 0.0 0.4 0.8 0.1 0.0 ( ) 2001 2000 ( ) 479 132 920 476, 359 ( ) 68.5% 100 399. 6-7 ( :, %) 478.6 132.0 920.0 531.7 437.9 410.7 421.2 723.8-100.0 27.6 192.2 111.1 91.5 85.8 88.0 151.3 407.6 124.0 859.0 475.5 355.8 347.7 354.3 630.8-100.0 30.4 210.7 116.6 87.3 85.3 86.9 154.8 29.0 8.0 102.0 30.0 28.2 22.2 22.8 54.5 5.5 0.0 45.0 6.7 4.5 6.6 5.7 3.3 36.5 0.0 395.0 19.5 49.5 34.2 38.4 35.2 ( )2001
136 6-8 ( :, %) 800 1 3.3 3.3 700 1 3.3 6.7 600 2 6.7 13.3 500 3 10.0 23.3 400 8 26.7 50.0 300 4 13.3 63.3 200 9 30.0 93.3 100 2 6.7 100.0 30 100.0 408 6-9 ( :, %) 800+ 1 7.7 7.7 - - - - - - 1 14.3 14.3 - - - 700+ 1 7.7 15.4 - - - - - - 1 14.3 28.6 - - - 600+ - - 15.4 2 11.8 11.8 1 11.1 11.1 1 14.3 42.9 - - - 500+ 3 23.1 38.5 - - 11.8 1 11.1 22.2 2 28.6 71.4 1 6.7 6.7 400+ 3 23.1 61.5 5 29.4 41.2 - - 22.2 - - 71.4 6 40.0 46.7 300+ 3 23.1 84.6 1 5.9 47.1 3 33.3 55.6 - - 71.4 1 6.7 53.3 200+ 2 15.4 100.0 7 41.2 88.2 3 33.3 88.9 - - 71.4 6 40.0 93.3 100+ - - 100.0 2 11.8 100.0 1 11.1 100.0 2 28.6 100.0 1 6.7 100.0 13 100.0 17 100.0 9 100.0 7 100.0 15 100.0 475 356 348 354 631 CT 1.21, MRI 1. MRI CT 1.13, 0.75
6 137 6-10 ( : ) CT scanner 1.21 0.42 1.31 1.13 1.00 1.21 1.50 MRI 1.00 0.38 1.15 0.87 0.75 1.00 1.33 0.43 0.50 0.62 0.27 0.38 0.21 1.00 C-Arm 0.96 0.79 0.92 1.00 0.63 0.86 1.67 0.54 0.58 0.62 0.47 0.38 0.43 1.00 0.79 0.63 0.77 0.80 0.75 0.71 1.00 0.61 0.57 0.62 0.60 0.75 0.29 1.17 ( ) 30 28 2).., ( ). 6-11 5-1% - - 20% ) - ( 200,, 100 ) ( ) 5 20% 30 (30 5 30 20%)
138 - (Minimum Requirement) - -. ( ) 5 10 3.2 1),,. 2001 5 2002 6 - (, ) 137, 38 2). (
6 139 32 3).. 30 100,, - : - : - :,,.,. ( ),...,
140 4. 4.1 1). (National Healthcare Expenditure),, (1993),,,.,, (1995) 3,.,, 1 OECD(2000b),,,,
6 141, OECD (System of Health Accounts; SHA) OECD (SHA). OECD 3.,,.,,,, OECD. (1997),,,,,,, 2),
142,,,,, 4.2 1), 2) (cost-benefit analysis).,,,.,
6 143., 3). ( 4, ) 4, 1, 1,.,,,,,,,.,. 10
144 DRG 20.6% ( 4 ), 20.6% 6-12 ( : %, ) drg 11 282 480,459,199 381,707,000 98,752,199 100 79.4 20.6 ( ) 0.69%.. 1% 1, 10% 2, 20% 3, 40% 4. 6-13 1 2 3 4 1% 10% 20% 40% 2001 178,843 129,406 72.4%. 132,364 74%. 6-14
6 145 6-14 2001 ( : ) 17,843,327 13,236,426 2,240,151 1,070,108 5,865,847 12,940,603 9,531,675 1,504,515 746,665 4,408,719 * = ( ) - 2001-1%, 10%, 20%, 40% - 20.6% = ( ) - 10.4% = ( ) ( ) - ( ) 74% 1 0.15%, 0.21%, 0.1%. 2 1.53%, 2.06%, 1.03%, 3 3.06%, 4.12%, 2.06%. 4 6.11%, 8.24%,
146 4.12%, 6-15 ( : %, ) 1 2 0.21 27,267 0.10 13,634 2.06 272,670 1.03 136,335 0.15 0.08 1.53 0.76 3 4 4.12 545,341 2.06 272,670 8.24 1,090,681 4.12 545,341 3.06 1.53 6.11 3.06 4). 7-2000 12, 42% 5 10
6 147 10,, 6-16 18,507 5,181 67,288 12 5 * 2001 1999 *,, 2002.. 28 2, 1 (2001) ( 1997) 40 6-17 ( : ) (1997) 43 106 45 43 10 ~ 20 28 2,
148 4.3m 2.. - = - = ( ) - = ( (1- ) - 1.67%, 20% 6-18 ( :, %, ), %, 40 400 40 604 1,920 9.44 210 1,050, %, 103 121 40 470 1,496 9.44 164 820 *', 2001, * 3 BBB- 02. 11. 26 ' ', ' ' 41.7%. 6-19 ( : %, ) 12 7 210 2,520 210 1,470 1,050 41.7 164 1,968 164 1,148 820 41.7
6 149 (2001) - = - = ( ) 6-20 ( : ) 100 150 125 416 2,080 30 45 38 163 815 *',, 2001. ' ', ' ' 41.7%. 6-21 ( : %, ) 12 7 416 4,992 416 2,912 2,080 41.7 163 1,956 163 1,141 815 41.7.
150.. 6-22 ( : ) 1 2 3 5% 10% 1 43 430 87 870 138 1,380 *,, 1997. * 2000 866 = + - = - 5-10 = 1 5% 43,
6 151 12 41.7%( 6-21), 1,345,901 2 10% 87, 870 1 2,723,102 3 1, (1997 ) 138 3 1,2, 4,319,403 1 703,050, 2 1,422,450, 3 2,256,300, 6-23 ( : ) 1 2 3 451,500 352,600 913,500 713,400 1,449,000 1,131,600 894,400 350,450 1,809,600 709,050 2,870,400 1,124,700 1,345,901 703,050 2,723,102 1,422,450 4,319,403 2,256,300 * (2001) 5), 20.6%, 1%
152 0.2%, 10% 2% 5% 703,050 1,345,901, 1 2,256,300 4,319,403,.,
7 153 7 1. 1. 1 1) 32 3( ). 32 3 ( )..,.
154.. - - ( ) - - 32 3( ) 30 ( : ) - 16) MRI CT,. 16) DRG DRG CT. ( :,, 2002.5)
7 155 - MRI CT ( ) ( : ) - ( ) ( : 17) ( ) ( ) (, ) ) - (Refer). 2001 18) - :, - :,, - : 17) ( ) 18) 65720-1677 (2001.11.16) CT.
156, - :.. 2)..,,.. 1.2 1)
7 157 - : - :,, 2) - :,, (,, ) - : - : 3). - -, ( )
158 7-1 ( ) ( ) (CT ) ( ) : (Refer) : : : : - ( ) / ( ) ( ) : / :. DRG : (DRG) DRG :... 1.3 1)
7 159 2) - - : 10 ( ) - - - 5 10 3) : 1.4 1) ( ).,,
160,,,,,. (, ) 1 1 -
7 16 1 -,, -,., - ( ),,.. 2)
162,, 1.5 :,. 2..,.. 19) 2001. 19) 2001 3 3 (1) - - (2) 2002 1 (3) ( :, 2001,, 2001.5)
7 163. 2. 1 1)... 2) ( 4 ). 1%. 3).
164 2.2 1). - - - -. - 2).. ( 2 2 1 ),
7 165 ( 12 1 ), ( 25 ),, ( 55 ). 30 6 22 23., 3) : 33 ( ) 2001 19 4) 5),
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