The Impact of Reimbursement Change Influencing Behaviors of Physician on Extracorporeal Shock Wave Lithotripsy Utilization

• Main Authors: Chia-Chen Hung, 洪嘉辰
• Other Authors: Gau-Jun Tang
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/y9hyap

碩士 === 國立陽明大學 === 醫務管理研究所 === 106 === Abstract Objectives: Extracorporeal shock wave lithotripsy is the most common treatment for upper urinary tract urolithiasis and also the highest outpatient payment unit for medical equipment usage. The aim of this study was determinate whether the urologist providing excessive ESWL after the reimbursement of ESWL changed since Jan. 1st, 2007 and to prove the “supplier-induced demand (SID)” hypothesis. Materials and Methods: The research sample was collected from LHID 2005 (Longitudinal Health Insurance Database 2005) and the study period was during 2000-2013. Prevalence of upper tract urolithiasis, demographic characteristics of stone patients and treatment trends were analyzed. Generalized linear model was used to for trends analysis after the imbursement changed. Result: Patients of upper urinary tract stone increased from 4303 in 2000 to 5887 in 2013, resulting in a 36.8% increase. From 2000 to 2013, patients diagnosed with urinary tract stone, the percent who received ESWL increased from 64% to 68%, those received URS decreased from 32% to 29.5% nd those received open surgery decreased from 1.3% to 0.3%. Utility of ESWL increased most obviously in the level of region hospitals. This research uses general linear model for trend analysis and shows ESWL use increased after reimbursement change in 2007 with statistically significant. Conclusions: In the face of income shock after reimbursement change, urologist increased the utilization of ESWL by both lowering the treatment indication and prolonging the treatment course, especially in level of region hospitals and district hospitals.