Impact of the DRG-based prospective payment system on medical utilization and outcomes of care for hip fracture and hip replacement
Journal
Taiwan Journal of Public Health
Journal Volume
34
Journal Issue
2
Pages
180-190
Date Issued
2015
Author(s)
Abstract
Objectives: To reduce rising health care costs, prospective payment systems based on diagnosis-related groups (DRGs) were introduced in the United States in 1983. Taiwan implemented the TW-DRG-based payment system in January 2010. Few studies have examined the impact of DRG-based payment systems on medical utilization and outcomes of care, and the results have been inconsistent. The objective of this study was to determine the impact of the TW-DRG-based payment system on medical use and outcomes of care for patients with hip fractures and patients undergoing hip replacement surgery. Methods: Data were derived from the nationwide sample through the National Health Insurance Research Database between 2008 and 2011. Patients admitted with a primary diagnosis of hip fracture or patients who underwent primary hip replacement surgery were selected for analysis. Segmented generalized estimating equations were used to determine the impact of the TW-DRG-based payment system on the length of stay, 30-day readmission rate, and 30-day mortality rate when adjusted for trend, patient, and hospital characteristics. Results: The implementation of the TW-DRG-based payment system was associated with a decrease in the length of stay, and with a decreasing trend in the 30-day readmission rate. Conclusions: The implementation of a DRG-based payment system in Taiwan led to a decline in the length of stay and a declining trend in the 30-day readmission rate. DRG-based payment systems might facilitate the development of a better model by which to contain medical utilization and improve readmission rates for patients with hip fractures and patients undergoing hip replacement surgery.
Publisher
Chinese Public Health Association of Taiwan
Type
journal article