| Summary: | 碩士 === 東海大學 === 工業工程與經營資訊學系 === 97 === This longitudinal, population-based, nation-wide study collected 15,449 patients who had received coronary artery bypass grafting (CABG) surgery during an eight-year and half period by 281 surgeons in Taiwan. The samples are drawn from the National Health Insurance Research Database (NHIRD). All cases share the same character of being reimbursed by National Health Insurance Bureau (NHIB) under the case-payment category implemented ever since July of 1999.
Using this administrative data, we investigated the cost-efficiency of all hospitals and surgeons undergoing CABG of this category and analyzed the associations between it and cumulative surgeon volume in addition to other parameters of hospitals and patients. “Cost” in this study specifically indicates “charge” of hospitalization. We take mean profit ratio as indicator of cost-efficiency; a lower ratio implies a higher efficiency.
General linear model (GLM) was used to explore associations between profit ratio per case and surgeon case volume (volume groups: One to 50, 51to 100, 101 to 150, 151 to 300 and >300), hospital ownership, accreditation status, geographic region; surgeon age, length of hospital stay and 7-day readmission. Data were statistically analyzed using SPSS 16.0 for Windows (SPSS Inc. Chicago, Illinois).
Results demonstrated surgeons performing cases between 151 to 300 and surgeons aged older than sixty have the lowest profit ratio among colleagues. Hospitals in northern area or public held performed best/better than their counterpart(s). Longer length of stay and readmission within a week after first discharge all brought profit ratio up. Private hospital, academic medical center and younger patient age predicted lower 7-day readmission possibility.
This is the first study focusing on cost-efficiency and associated surgical outcomes of CABG reimbursed by case-payment mechanism. This transitional payment system is to pass down the mission to a more continent Tw-DRGs in near future. Our study might act as a pilot for more precisely defining the implementation of Tw-DRGs.
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