| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 104 === Background: The National Health Insurance has been introduced since 1995, and several payment reforms have been implemented, including Taiwan diagnosis related group (Tw-DRGs). Under the prospective payment system with a pre-determined payment standard, hospitals tend to reduce medical service or select patients. Patients with multiple chronic conditions (MCCs) usually consume more medical resource than others. However, the impact of DRG payment on patients with multiple chronic conditions has not been examined.
Object: This study was to examine the impacts of implementing Tw-DRGs systems on medical resource usage and health care outcomes for patients with MCCs.
Methods: Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty were included as the intervention group, and the comparison group consisted of patients who underwent the MDC5 surgeries which were not yet included in the Tw-DRGs. The data used was from
National Health Insurance Research Database, from 2008 to 2010. Propensity score matching was used to enhance the comparability between subjects before and after the implementation of DRG, and the generalized estimating equations model and difference-in-difference analysis was also used in this study.
Result: The introduction of DRG payment resulted in decrease in patient’s length of stay, the number of medication orders, and total inpatient expenses in the intervention group in relation to the comparison group, yet no significant changes were found concerning health care outcomes. However, in the intervention group, we found no significant difference between MCC patients and non-MCC patients in medical resource use and health care outcomes.
Conclusion: For the patients underwent cardiac surgery, the implementation of Tw-DRGs did not result in the differences in medical resources consumption or health care outcome between MCC patients and non-MCC patients. We suggest that more analysis on various kinds of diagnosis groups should be conducted and the findings may be useful for the National Health Insurance Administration DRG payment system.
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