The Impact of Second Phase in Taiwan Diagnosis Related Groups Payment System on Medical Utilization and Care Quality-An Analysis Based on MDC5

• Main Authors: Ho, Yu-Wen, 何玉雯
• Other Authors: Li, Chun-Ju
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/s95a6e

碩士 === 靜宜大學 === 管理碩士在職專班 === 103 === National Health Insurance (NHI) program, which is a mandatory enrollment and single payment system created in 1995 that covers over 99% of Taiwan’s population. The insurance system entered into 20th years. In order to distribute the medical resource and promote the efficiency of managing reasonably,The National Health Insurance Administration (NHIA) was implemented since January 1st, 2010 and is proposed to its full implementation within five years introducing Taiwan Diagnosis Related Groups (Tw-DRGs) payment system. From the perspective of hospital management, the system test the ability of hospital management cost control. If the control improperly, the operation may be influenced. This study explored the effects on medical utilization 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 a total of 1,589 inpatient cases from January 2014 to December 2014. The Major Diagnostic Category 5(MDC5) cases were selected to compare the difference before and after the Tw-DRGs second phase implemented. The finding and conclusion of this study are: 一、On Medical Utilization: 1.Decreased of the length of hospital stay, but medical expenditures per patient increased. However,the differences varied among medial specializations. The study showed that the length of hospital stay is not the major cause for affecting the medical expenditures.But decreasing in average length of hospital stay help enhance the hospital bed turnover rate, It shorted the time for patients to wait for beds. 2.Increased health care costs for the difference between the display after the second phase of implementation of hospital finance is helpful . For the National Health Insurance Administration (NHIA),it is reasonably to convince health care providers, early arrival of the full implementation of DRG payment system. 3.The days of hospital stay decreased in Men,the actual medical care costs fell,while the cost of the transfer points increase,it showed a cost shift to outpatient case. The days of hospitalization in patients over 65 years old reduced while the actual medical payment and the cost of the transfer points increased that shows the more elder patients are, the more actual medical payment costs. We should be concerned about it and follow up. 二、On medical care quality: Two measures of quality of care (Readmission rate within 14 days and come back to emergency room within 3 days for the same reason),although there were no significant difference before and after the implementation,but the percentage still reduced which display quality of care did not bring down owing to the implementation of the second phase of Tw-DRGs. Suggestion: 1.Competent authority should design the rational payment systems,the efficient allocation of medical resources and avoid to reduce payments because the system is unfair which may result in doctors gone away.On the condition may be at the expense of patient's medical treatment indirectly. 2.Hospital managers: Although every hospital managers want to get more paid and adapt to changes from the system,but should not sacrifice patient's right to reduce examination or treatment which should done.All procedure should returned to the medical professional own ability to make decisions. 3.The two sides should establish a communication mechanism to maintain mutual trust and national health interests.