The Comparison of Medical Resources Utilization before and after Intervention of Tw-DRGs: An example of Orthopedics epartment of a Northern Regional Teaching Hospital
Date Issued
2014
Date
2014
Author(s)
Yang, Shih-Hsien
Abstract
Introduction
Since National Health Insurance of Taiwan was implemented in 1995, we were always finding the best solution to keep the finance balance. Although the Bureau of National Health Insurance implemented a lot of payment systems which purpose was to decrease the medical expenditures. In 1983, US government implemented the payment system of Diagnosis Related Groups （DRGs） which has been adopted by many countries in the world. So, the Bureau of National Health Insurance decided to implement Tw-DRGs payment system in 2010 to suppress the continuous growth of the medical expenditures.
Purpose
The purpose of this study is to compare the medical resources utilization of orthopedic department before and after intervention of Tw-DRGs. We want to understand whether the medical resource utilization changes after the implementation of Tw-DRGs payment system.
Materials and Methods
A northern regional teaching hospital was selected and the study was held in the orthopedic department. The admission claim data by "case payment" was collected from January 1, 2008 to December 31 2009 and the admission claim data by "Tw-DRGs" was collected from January 1, 2010 to December 31 2011. The medical resource utilization was analyzed including length of stay, medical detailed cost, and the discrepancy between actual medical cost and claim cost. The cases of spinal surgery （ICD-9CM Code: 720 to 724）which were neither in the case payment group nor in the Tw-DRGs group were also collected for control group.
Results
In almost all groups, the discrepancy between actual medical cost and claim cost increased with significant difference. The length of stay decreased with significant difference in two groups. The radiologic cost increased with significant difference in four groups. In the control group, the medical resource utilization was not significantly different before and after the implementation of Tw-DRGs.
Conclusions
The medical resource utilization in the orthopedic department was not significantly different in both groups. But the discrepancy between actual medical cost and claim cost increased in almost all the groups mainly due to decreasing of length of stay. So, the medical expenditure will decrease under the surveillance mechanism.
Subjects
Tw-DRGs
疾病診斷關聯群
醫療資源耗用
骨科
Type
thesis
File(s)![Thumbnail Image]()
Loading...
Name
ntu-103-P98843001-1.pdf
Size
23.32 KB
Format
Adobe PDF
Checksum
(MD5):bdf165b124bcc9cb326acc6d7f49b8da