Analysis of Cost Differences by Tw-DRG Confirmation Time Interval and Clinical Department in a Regional Hospital of Central Taiwan

Autor: Wan-Ru Chen, 陳婉汝
Rok vydání: 2014
Druh dokumentu: 學位論文 ; thesis
Popis: 102
Background: Taiwan has launched Diagnosis Related Groups (Tw-DRGs) for an inpatient reimbursement scheme under National Health Insurance (NHI) since January 1, 2010, in the attempt to reduce unnecessary medical services and, therefore, to further achieve cost-effective medical care with reasonable hospital benefits. Given that patients may receive intensive clinical tests shortly before hospitalization, high expenses occur possibly in the median length of stay. Therefore, if Tw-DRGs can be determined with the least delay when patients are being admitted, the subsequent treatments can be appropriately scheduled, leading to more accurate cost control. However, there is a dearth of analyses on the effects of Tw-DRGs confirmation intervals and clinical departments on medical costs. The present study sought to analyze the cost by the interval of Tw-DRGs prescription confirmation and clinical department, aiming to reaching effective cost control. Methods: In the design of retrospective analysis for medical records, 650 discharged patients of hernia operations and 567 of spinal operations from January, 2012 to February, 2014 in a regional hospital of central Taiwan were the study samples collected. Analysis methods included descriptive statistics and inferential statistics which contain independent t-Test, ANOVA, general linear model (GLM), and binomial logistic regression analysis conducted in SPSS 18.0. Results: A majority of patients with hernia surgery were male (87.4%), outpatient source (92.9%), and aged higher than 70 (29.4%). Factors associated with whether the medical expense is above quota included the Tw-DRG confirmation time interval, clinical department, and patient source. GLM results indicated that, in terms of medical cost saving ratio, 12-24 hours of confirmation interval was lower than 0-2 hours, 2-4 hours, and 4-8 hours; outpatients were higher than other sources. Most spinal surgery patients were male (54.7%), outpatient source (85%), and aged higher than 70 (25.9%). The adjusted results showed that the Tw-DRG confirmation time interval, clinical department, and patient characteristics were not associated with significant difference in the medical expenses. Conclusion: With regards to hernia surgery, department of general surgery and shorter Tw-DRG confirmation time interval were associated with a decrease in the medical expenses. Medical expenses decreased almost linearly with the Tw-DRG confirmation time interval. It is suggested that healthcare providers should determine the Tw-DRG with a shortest delay to ensure that succeeding treatments receive a lowered medical cost.
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