Impact of TW-DRGs Payment System on Medical Care Utilization, Provider’s Behavior and Medical Care Quality Using Coronary Artery Bypass Graft Surgery as an Example

• Main Authors: Kuei-Miao Kuo, 郭奎妙
• Other Authors: 楊銘欽
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/70237854026497809786

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 100 === Since March 1, 1995, Taiwan has implemented the National Health Insurance (NHI) Program. However, this program is facing the cost-increasing problem, and therefore the government keeps on looking for effective solutions. In the beginning of 2010, NHI program implemented TW-DRGs based Prospective Payment System. This study wanted to analyze its impact on medical care utilization, provider’s behavior, and medical care quality while payment system changed from the previous to TW-DRGs—using coronary artery bypass graft (CABG) surgery as an example. This study selected those who received CABG surgery in 2009 or 2010 from “2005 sampling cohort database of 1,000,000 insureds” of National Health Insurance Research Database (NHIRD). With SAS 9.2 software, this study tested the hypotheses by Chi-square test, Fisher’s Exact Test, t test, Wilcoxon Rank Sum Test, and multiple regressions. Results: After controlling for the confounding factors, the length of stay and medical expense decreased after TW-DRG although not significant. Besides, cost shifting was not detected, and medical care quality did not change after implementing TW-DRGs system. Conclusions: After implementing TW-DRGs system in 2010, there were some differences in medical care utilization, provider’s behavior and medical care quality but did not reach statistical significant.