| Summary: | 碩士 === 輔仁大學 === 公共衛生學系碩士班 === 99 === Since the launch of National Health Insurance program in March 1995, many payment systems were rolled out in hope to effectively control the increase of medical cost and decrease the waste of medical resources. The Bureau of National Health Insurance (BNHI) wishes to use effective payment systems to alleviate the financial burden for the people, and at the same time maintain the quality of health care and protect the safety of the people. As a result, Taiwan Diagnosis-related Groups (Tw-DRGs) was put in place. Before implementing Tw-DRGs, many case payment systems were carried out step by step to increase self-control of the cost by the health-care providers and to decrease the rise of medical costs. These systems have considerable results after many years. Thus, after many years of planning, the BNHI started the Tw-DRGs system in January 2010 for the goals of controlling the waste of medical resources and protecting the quality of medical care.
Goals: The goal of this study was to compare medical care utilization, including inpatient costs and outpatient costs, and medical care quality, including days of hospitalization, re-admission and frequency of outpatient clinic visits, before and after Tw-DRGs. We also investigated the influential factors, such as the characteristics of the patients and the physicians.
Methods: The study used the data of medical costs provided by a community hospital in northern Taiwan to compare the medical care utilization and medical care quality before and after Tw-DRGs for five diseases, including four diseases that were already paid by case and one disease that was paid fee for service.
Results: The costs for inpatient hospitalization and outpatient clinic visits had no significant differences after Tw-DRGs, indicating no transfer of costs after the new payment system. The days of hospitalization, re-admission rate and frequency of outpatient clinic visits for all diseases were not increased or decreased with a trend, indicating the quality of medical care was not changed due to the new payment system. This result came from mostly the diseases that were already paid by case before Tw-DRGs, therefore may not show any significant changes during the first year. We hope to continue observing the effects for the second year and understand more about the impacts of Tw-DRGs to the medical environment.
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