The Impacts of Case Payment System and Tw-DRGs System on the Medical Resource Utilization

• Main Authors: Hou, Tzuling, 侯姿伶
• Other Authors: Hsu, Pifem
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/47623356469540543625

碩士 === 義守大學 === 管理學院管理碩士在職專班 === 101 === In order to control the increasing medical expenses, the reimbursement policy of Tw-DRGs was adopted by National Health Insurance (NHI) to replace the case payment method since January 2010. In this study, the utilization of medical resources was compared between these two reimbursement methods of case payment and Tw-DRGs. We want to ask whether the medical cost, the length of stay and unnecessary payment have been reduced by the reimbursement policy of Tw-DRGs. The study concluded 932 circulatory disease patients who had been admitted to a southern regional hospital. The regression analysis was adopted to estimate the effect of the implementation of Tw-DRGs. The results show that the Tw-DRGs payment system significantly reduced the differences between medical cost and obtained NHI’s payment. But the length of stay has not been reduced by the Tw-DRGs method. In addition, the differences between medical cost and obtained NHI’s payment were reduced by the case composition and the characteristics of patients and doctors. The age and gender of patients also have effect on the medical cost of the hospital. The estimated results imply that Tw-DRGs would reduce the difference between the medical costs and obtained NHI’s payment. Therefore, the reimbursement policy of Tw-DRGs improves the utilization efficiency of medical resources by reducing unnecessary payment.