Evaluating the performance of a hospitalist system in Taiwan: A pioneer study for nationwide health insurance in Asia
Journal
Journal of Hospital Medicine
Journal Volume
6
Journal Issue
7
Pages
378-382
Date Issued
2011
Author(s)
Abstract
Background: The national health insurance (NHI) in Taiwan covers almost the entire population and controls medical costs. However, there is increasing patient admission and shortage of inpatient care staff. The hospitalist system may be a solution. Objective: To study the efficiency of the hospitalist system under the NHI in Taiwan. Design: Prospective observational study. Methods: Under the NHI, a hospitalist-run ward (HW) was set-up in a medical referral center for patients admitted from the emergency department. The cohort was observed and compared to the internist-run wards (IWs) in terms of performance. Results: From November 2009 to January 2010, 377 patients admitted to the HW and 433 to the IWs were enrolled. Patients in the HW were older and had poorer functional status and more underlying comorbidities. The HW group also had lower admission costs and shorter lengths of hospital stay (LOS) than the IW group. Due to different demographics, propensity analysis was performed on 101 matched pairs of patients, which showed significantly lower cost and shorter LOS in HW patients despite similar mortality and readmission rates. Conclusions: The hospitalist system has higher efficiency than the internist-run general wards under the NHI system in terms of costs and length of hospitalization. It may serve as an alternative model to address rising admissions and staff shortages. ? 2011 Society of Hospital Medicine.
Other Subjects
aged; article; Asia; comorbidity; controlled study; emergency ward; female; functional status; health care quality; hospital admission; hospital cost; hospital management; hospital readmission; human; laboratory test; length of stay; major clinical study; male; medical staff; mortality; national health insurance; outcome assessment; priority journal; Taiwan; Aged; Asia; Female; Follow-Up Studies; Hospitalists; Hospitalization; Humans; Male; Middle Aged; National Health Programs; Prospective Studies; Taiwan
Type
journal article