成年人扁桃腺切除手術論病例計酬制實施之影響評估

The Impacts of Case Payment System on the Practice of Adult Tonsillectomy

王拔群(Pa-Chun Wang) ； 張燕良(Yen-Liang Chang) ； 黃麗萍(Li-Ping Huang) ； 龔聖祐(Sheng-Yu Kung) ； 蕭曉霽(Hsiao-Chi Hsiao) ； 楊凱婷(Kai-Ting Yang) ； 鍾佩雯(Pei-Wen Chung)

《慈濟醫學雜誌》 16卷4期 (2004/08) Pp. 227-234

https://doi.org/10.6440/TZUCMJ.200408.0227

摘要

Objective: The objectives of this study were to investigate the impact of the case payment system on the practice of adult tonsillectomy. Materials and Methods: A total of 54 adult patients, who had suffered from chronic tonsillitis and who had underwent tonsillectomy at a medical center during the period from March 1998 to March 2000, were enrolled. Surgical outcomes, medical resource utilization, and healthcare costs were compared between the groups of patients who were operated before (29 patients) and after (25 patients) the implementation of the case payment system for tonsillectomy on March 1999. Analyses were conducted using the Mann-Whiney U test and the Fisher's exact test. Results: The surgical outcomes were indistinguishable between two groups (P＞0.05) and although the average length of stay was shorter by 0.3 day, this also was not significant (P＞0.05). We found behavior with respect to prescriptions was significantly modified. Both oral and intravenous medications were significantly reduced with a 3% reduction in cost. The total up-front admission costs were reduced by 20% and this mainly stemmed from simplified and unified surgery claims. There was no evidence of a cost shift to outpatient services. The outcomes indicators, such as re-admission, re-operation, complication, and prolonged hospitalization, were indistinguishable between the two groups (P＞0.05). Conclusion: The implication of case payment system was shown to be effective and there was an enhancement in the efficiency of adult tonsillectomy; a small part of this was associated with modification of the provider prescription behavior. However, the cost reduction identified in this study mainly stemmed from simplified and unified surgery claims. The impact of the new payment system on the quality of patient care requires further observation.

關鍵字

扁桃腺切除手術 ； 論病例計酬支付制度 ； 醫療資源使用

並列摘要

Objective: The objectives of this study were to investigate the impact of the case payment system on the practice of adult tonsillectomy. Materials and Methods: A total of 54 adult patients, who had suffered from chronic tonsillitis and who had underwent tonsillectomy at a medical center during the period from March 1998 to March 2000, were enrolled. Surgical outcomes, medical resource utilization, and healthcare costs were compared between the groups of patients who were operated before (29 patients) and after (25 patients) the implementation of the case payment system for tonsillectomy on March 1999. Analyses were conducted using the Mann-Whiney U test and the Fisher's exact test. Results: The surgical outcomes were indistinguishable between two groups (P＞0.05) and although the average length of stay was shorter by 0.3 day, this also was not significant (P＞0.05). We found behavior with respect to prescriptions was significantly modified. Both oral and intravenous medications were significantly reduced with a 3% reduction in cost. The total up-front admission costs were reduced by 20% and this mainly stemmed from simplified and unified surgery claims. There was no evidence of a cost shift to outpatient services. The outcomes indicators, such as re-admission, re-operation, complication, and prolonged hospitalization, were indistinguishable between the two groups (P＞0.05). Conclusion: The implication of case payment system was shown to be effective and there was an enhancement in the efficiency of adult tonsillectomy; a small part of this was associated with modification of the provider prescription behavior. However, the cost reduction identified in this study mainly stemmed from simplified and unified surgery claims. The impact of the new payment system on the quality of patient care requires further observation.

並列關鍵字

tonsillectomy ； case payment system ； medical resources utilization