| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 106 === Background: In order to effectively enhance the quality and efficiency of care, Taiwan’s version of diagnosis related groups (Tw-DRGs) launched in 2010. Under the prospective system, patients within each category are clinically similar and are expected to use the same level of medical resources and health care costs. However, patients with multiple chronic conditions usually needed more medical resources. Tw-DRGs was implemented eight years ago, many studies have examined whether Tw-DRGs contributes to reduced resource usage, as does its effects on healthcare quality. Few studies have been conducted to investigate the impact of Tw-DRGs payment system on patients with multiple chronic conditions.
Objectives: The purpose of this study was to determine the impact of the Taiwan Diagnosis Related Groups (Tw-DRGs) payment system treating patients with Cardiac Catheterization and examine medical expenses and quality of care for patients with multiple chronic conditions.
Methods: Patient-related data were obtained from the National Health Insurance data warehouse during the study period (2008-2011). To eliminated sample bias and misclassification, we select the representative sample from population and patients are assigned to DRG with EXM_RESULT_DRG in claim data. Patients who underwent Cardiac Catheterization as the intervention group and the comparsion group who underwent MDC5 intervention which were not phased in study period. Propensity score matching (PSM) was used to divide the subjects into DRG and non-DRG groups. The difference-in-difference-in-difference approach and the generalized estimating equation (GEE) model were used to compare the DRG and non-DRG groups with multiple chronic conditions on their medical usage and health outcome.
Results: After Tw-DRGs were implemented, we found no significant difference between patients with multiple chronic conditions and patients without multiple chronic conditions in medical usage and health outcome. However, after Tw-DRGs was initiated, the DRG group had lower medical expenses, lower length of stay, higher medical expense shifting outpatient and lower number of orders for diagnosis or treatment. The mortality rate within 30 days after discharge and ED visits within 3 days after discharge compared to the non-DRG group were not significant. In contrast, after Tw-DRGs were implemented, the DRG group had a higher readmission rate within 30 days after discharge compared to the non-DRG group.
Conclusions: After implementing the Tw-DRGs payment system, the medical usage and health outcome did not lead to the difference in patients with multiple chronic conditions and patients without multiple chronic conditions. We suggest that a sensitivity analysis used to determine how different values of an independent variable impact dependent variables under a given set of MCC assumptions.
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