Association of the Tw-DRGs and Market Competition upon Medical Resource Utilization and Quality of Care Using Cardiac Cath, PTCA and CABG as an example
Date Issued
2015
Date
2015
Author(s)
Liang, Chun-Chieh
Abstract
According to Organization for Economic Co-operation and Development (OECD) report, healthcare expenditure increasing globally, Taiwan is included. Before universal health insurance implementation, the insurer was eager to solve the issues of the increasing healthcare expenses. However, the issue had not be solved as National Health Insurance implement on March 1, 1995. To terminate the rate increasing, National Insurance Administration adapted several strategies, including elevating the premium rate and payment system reform. In order to decrease medical resource utilization, to improve quality, and decreasing the financial risk, Tw-DRGs implemented in Taiwan on January 1, 2010. Even though several studies has evaluated the efficacy of Tw-DRGs, the studies conclusion is inconsistent, simultaneously, those did not assess the association between market structure and outcomes. Thus, this study aimed to assess the impact of Tw-DRGs implementation on medical resource utilization and quality, the association of market competition on medical resource utilization and quality under Tw-DRGs for cardiac cath, Percutaneous Transluminal Coronary Angioplasty (PTCA), Coronary Artery Bypass Graft (CABG) surgery conducting in medical centers and residential hospitals from2007 to 2011. This study aimed to assess the impact of Tw-DRGs implementation on medical resource utilization and quality, the association of market competition on medical resource utilization and quality under Tw-DRGs. This study used National Health Insurance Research Database (NHIRD) of Taiwan from 2006 to 2012. The data included cardiac cath, Percutaneous Transluminal Coronary Angioplasty (PTCA), Coronary Artery Bypass Graft (CABG) surgery conducting in medical centers and residential hospitals from2007 to 2011. The indicators of medical resource utilization included length of stay and medical cost, and the indicators quality 30- day readmission rate, 30-day post-discharge mortality rate. Using SAS 9.3 software, statistical analysis included description, multi-variant analysis, and Hierarchical linear growth model. Under Hierarchical linear growth model, as considering hospital characteristics Tw-DRGs caused length of stay decreasing 6.3% per year, average cost reducing 6% per year, 30- day readmission rate before calibration increasing 0.8605% per year, and 30- day readmission rate after calibration growing 13.43% per year. As evaluating the impact of market competition on hospital medical resource utilization and quality under Tw-DRGs, the market competitions had not correlation with medical resource utilization and quality. As the results, Tw-DRGs had positive impact on hospital medical resource utilization, elsewise, Tw-DRGs had a little negative effect on quality. In addition, there was no significant association to medical resource utilization and quality. This study indicated quality assessment system of Tw-DRGs might failure. Therefore, the health policy authorities might improve quality through adapting appropriate intervention approach.
Subjects
Tw-DRGs
Medical Resource Utilization
Quality
Growth Model
National Health Insurance Research Database (NHIRD)
SDGs
Type
thesis
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