Projecting the impact of Tw-DRG payment system on hospital performance：using a regional hospital as an example
Date Issued
2008
Date
2008
Author(s)
Chiang, Shueh-Ping
Abstract
Purposes:he study attempted to reveal the impact of Taiwan-Diagnosis-Related Groups ( TW-DRG ) payment system on the performance of hospital administpredetermined payment. Its aims are: (1) to comprehend the ratios of difference to predetermined payment by different MDC under DRG payment system, (2) to show the variance of ratios of difference to predetermined payment among various specialists, and (3) to explore major factors influencing the ratio of difference to predetermined payment under an identical DRG.ethods:he study was a secondary retrospective data analysis.The subject was one public regional teaching hospital in northeasten Taiwan. Hospitalization data of total 12406 cases filed to the Bureau of National Health Insurance (BNHI) in 2007 was collected . This study calculated the ratio of the difference, between actual medical expense and DRG predetermined payemt and caculates the ratio of the difference to DRG predetermined payment by formula of TW-DRG payment system, the 3rd edition, and implemented at the 4th phase. The results were used to test our hypotheses.esults:he ratio of difference to predetermined payment could be a quantitative indicator and could be applied to evaluate the influence of hospital finance by implementing TW-DRG payment system. The study revealed several results as follow: (1) The influence of different MDC on the ratio of difference to predetermined payment varied to some extent, the proportion of financial risks were also depended on the proportion of service and the rate of total payment. (2) The influence of specialty and seniority on the ratio of difference to predetermined payment also varied, The specialist of a disease didn’t always gain positive benefit, while the seniority did. (3) The length of stay was the major factor of financial risk. the negative ratio of difference to predetermined payment indicated loss and disadvantage of hospital finance. (4) TheALOS was a good indicator for loss or surpluss of hospital finance.onclusions:verall, the alteration of payment system will be sure to influence the hospital finance and hospital management. The study helps hospital managers to evaluate the loss of medical service and to find the factors influence finalcial surpluss or loss. It cannot be overemphasized that maintaining the performance of hospital administration should depend on closely monitoring the risk factors including characteristics of patients, disease patterns, and medical expertise, and appropriate reaction and adjustment in time.
Subjects
Tw-DRG payment system
the ratio of difference to predetermined payment
risk measurement
hospital performance
Type
thesis
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