The Impact of Taiwan Diagnosis Related Groups on Medical Utilization and Care Quality

• Main Authors: Hui-Chen Lin, 林惠珍
• Other Authors: Min-Sheng Chen
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/73839313641777585103

碩士 === 國立雲林科技大學 === 健康產業管理研究所碩士班 === 99 === The Bureau of National Health Insurance changed the payment system in order to effectively control the growth of medical expenditures and maintain good healthcare quality as well. Taiwan Diagnosis Related Groups（Tw-DRGs）is the payment system designed to bind the homogeneous units of hospital activities to the same prices. This system was implemented since January 1st, 2010 in Taiwan, and is proposed to its full implementation within five years. The top priority for the first year was the implementation of 155 DRGs which were previously the case payment items. This study explored the effects on medical utilization, cost shifting, and healthcare quality due to the implementation of Tw-DRGs by using secondary data analysis. Our study data derived from a regional teaching hospital and collected 3,270 inpatient cases claims from January 2009 to December 2010. In addition, these inpatients cases were divided into two groups, each group represented before and after the implementation of Tw-DRGs respectively. The major findings of this study are: 1. After Tw-DRGs, we found the decreased in average of the length of stay, while the average of medical expenditures per patient increased. However, the differences varied among medical specializations. The study showed that the length of stay is not the major cause for affecting the medical expenditures which did not match the findings from other studies that stated the implementation of prospective payment system can reduce both length of stay and medical expenditures. In addition, due to the increase in special materials, the orthopedics department had statistical significance in the increase of medical expenditures. 2. The results showed that the cost shifting among medical specializations varied. However, we found that part of ENT’s inpatient costs was significantly transferred to outpatient services. 3. As for the 14-day readmission rate, there were no significant differences. After the Tw-DRGs was 0.6% maintaining the same level before the Tw-DRGs. In other words, the implementation of Tw-DRGs did not have significant influence on the quality of medical care. 4. There were several differences among patients’ demographics such as gender, age and medical utilization. First, female had longer length of stay than male. Besides, female also had higher medical expenditures than male. Furthermore, the older the patients the longer the length of stay and the higher medical expenditures for the various surgery categories among the medical specializations. The results of this study can be of references to the Bureau of National Health Insurance and hospital administrators. Moreover, the researchers can have the further study on the national level databases in assisting the authorities developing appropriate policies which can help the country effectively utilize medical resources and improve healthcare quality.