Are Patient Clinical Resource Consumptions Homogeneous within the Case Payment Items?

論病例計酬項目內病人的臨床資源耗用是否為同質性？

林匡慶(Herng-Ching Lin) ； 董鈺琪(Yu-Chi Tung) ； 楊長興(Chiang-Hsing Yang) ； 王炳龍(Bill-Binglong Wang)

《醫務管理期刊》 3卷1期 (2002/03) Pp. 107-119

摘要

With the advent of the Taiwan National Health Insurance, the Bureau of the National Health Insurance (BNHI) has implemented the case payment system since 1995. Concerns have been raised about within-group variations in resource consumption of each case payment item. This study used patient undergoing a vaginal delivery and a femoral or inguinal hernia operation. The purpose of this study is to investigate whether patient clinical resource consumption varies within case payment items due to the ICD-9-CM classification scheme.
This study used the National Health Insurance Research Database (NHIRD) of 2000. A total of 6764 patients in the study were identified on the basis of the specific case payment codes of 0373A (vaginal delivery) and 0163A (femoral or inguinal hernia operation). The multiple regression analyses were performed by which length of stay (LOS) or cost was regressed against the independent variable of the principal procedure code.
This study revealed that there was a significant relationship between LOS and the principal procedure for patients undergoing a vaginal delivery (p=0.000 for codes of 73.6 vs 72.7l, p=0.021 for codes of 73.6 vs 73.59) and femoral or inguinal hernia operation (p=0.000 for codes of 53.00 vs 53.02) after adjusting for hospital ownership, hospital level, hospital teaching status, patient’s age and gender. The costs per discharge was also related to principal procedure for patients undergoing a vaginal delivery (p=0.000 for codes of 73.6 vs 7271, p=0.001 for codes of 73.6 vs 73.59) and femoral or inguinal hernia operation (p=0.000 for 53.01 vs 53.02, p=0.001 for 53.00 vs 53.02).
The results suggest that there exist variations in clinical resource consumption among patients treated with different principal procedures within case payment items of vaginal delivery and femoral or inguinal hernia operation. How to update and improve the resource homogeneity of case payment items has become an imperative issue for the implementation of case payment in Taiwan.

關鍵字

論病例計酬支付 ； 同質性 ； 平均住院日

並列摘要

With the advent of the Taiwan National Health Insurance, the Bureau of the National Health Insurance (BNHI) has implemented the case payment system since 1995. Concerns have been raised about within-group variations in resource consumption of each case payment item. This study used patient undergoing a vaginal delivery and a femoral or inguinal hernia operation. The purpose of this study is to investigate whether patient clinical resource consumption varies within case payment items due to the ICD-9-CM classification scheme.
This study used the National Health Insurance Research Database (NHIRD) of 2000. A total of 6764 patients in the study were identified on the basis of the specific case payment codes of 0373A (vaginal delivery) and 0163A (femoral or inguinal hernia operation). The multiple regression analyses were performed by which length of stay (LOS) or cost was regressed against the independent variable of the principal procedure code.
This study revealed that there was a significant relationship between LOS and the principal procedure for patients undergoing a vaginal delivery (p=0.000 for codes of 73.6 vs 72.7l, p=0.021 for codes of 73.6 vs 73.59) and femoral or inguinal hernia operation (p=0.000 for codes of 53.00 vs 53.02) after adjusting for hospital ownership, hospital level, hospital teaching status, patient’s age and gender. The costs per discharge was also related to principal procedure for patients undergoing a vaginal delivery (p=0.000 for codes of 73.6 vs 7271, p=0.001 for codes of 73.6 vs 73.59) and femoral or inguinal hernia operation (p=0.000 for 53.01 vs 53.02, p=0.001 for 53.00 vs 53.02).
The results suggest that there exist variations in clinical resource consumption among patients treated with different principal procedures within case payment items of vaginal delivery and femoral or inguinal hernia operation. How to update and improve the resource homogeneity of case payment items has become an imperative issue for the implementation of case payment in Taiwan.

並列關鍵字

case payment ； homogeneity ； LOS

參考文獻

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Averill R.F.,Mullin R.L.,Steinbeck B.A.,Goldfield N.J.,Grant T.M.(1998).Development of the ICD-10 Procedure Coding System （ICD-10-PCS）.Journal of AHIMA.69,65-72.

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Horn S.D.,Horn R.A.,Sharkey P.D.,Beall R.J.,Hoff J.S.,Rosenstein B.J.(1986).Misclassification problems in diagnosis-related groups. Cystic fibrosis as an example.New England Journal of Medicine.314,484-487.

Horn S.D.,Sharkey P.D.(1983).Measuring severity of illness to predict patient resource use within DRGs.Inquiry.20,314-321.