| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 102 === Background: To improve healthcare quality and efficiency, many countries have implemented Diagnosis Related Groups (DRGs) and this has proven to the effect the payment system of many hospital. Since 2010, the Bureau of National Health Insurance (NHI) had introduced Taiwan Diagnosis Related Groups (Tw-DRGs), and it’s important to examine the hospital performances in Taiwan.
Objective: The goal of this study was to investigate the entire hospital performances and the performances under three different claimed case types after the new payment system was implemented.
Methods: This study was based on a retrospective cohort study design and observed hospitals that were in service both in 2009 and 2010. The Tw-DRG’s code was created by NHI DRGs software. The study compared the differences in the annual average numbers of coded diagnoses and operation, case-mix index (CMI), average length of stay (ALOS), numbers of coded diagnosis or operation, medical expense, and readmission rates before and after the payment system was introduced. The statistical analysis was conducted by SAS9.3 and paired t-test, repeated measures ANOVA, and Generalized Estimating Equation (GEE) were adopted.
Results: After the Tw-DRGs introduction, the hospitals’ performance improved significantly. The coded number of diagnosis increased 0.173, the coded numbers of operation increased 0.192 and ALOS decreased 9.5%. However, the readmission rate in the same division of hospital in 30 days increased 9.6%. In claimed Tw-DRGs cases, ALOS, the numbers of diagnostic code, operational code, and CMI improved significantly, but the base rate (BR) increased. In claimed normal cases, the numbers of diagnostic code, operational code and ALOS improved. But the readmission rates in 30 days and in the same division in 30 days increased.
Conclusion: Implementing Tw-DRGs had an impact on the performances of hospitals. The claimed Tw-DRGs cases had improved better than other cases. From the results of high readmission rates of normal cases, it could be inferred that there might be a shift between different claimed data after the phase-in introduction of Tw-DRGs. It is suggested that the authorities should keep supervising the changes of hospital performances and accelerate overall introduction of Tw-DRGs.
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