實施論病例計酬制對成人扁桃腺切除手術執行之影響

A Study on the Impacts of Case Payment System for Adult Tonsillectomy

王拔群(Pa-Chun Wang) ； 張燕良(Yen-Liang Chang) ； 陳雅惠(Ya-Hui Chen) ； 戴志展(Chih-Jaan Tai)

《台灣耳鼻喉頭頸外科雜誌》 40卷5期 (2005/08) Pp. 193-200

https://doi.org/10.6286/2005.40.5.193

摘要

BACKGROUND: Using National Healthcare Insurance Database, we investigate the impacts of case payment system on medical expenses, outcomes and utilization for adult tonsillectomy.
METHODS: A total of 2,099 adult patients with chronic tonsillitis who underwent tonsillectomy during the period from March, 1998 to March, 2000 were identified. Surgical outcomes, medical resource utilization, and healthcare expenses were compared between groups of patients who were operated before (1,022 patients) and after (1,077 patients) the implementation of tonsillectomy case payment system on March 1999. Analyses were conducted using t-test and Chi-square test.
RESULTS: The average length of stay was shorten by 0.7 days (p＜0.05), and the total claimed amount was increased by 1.5% in average, but claimed medication fee, operation fee, and ward fee were reduced by 25.1%, 11.9%, and 10.4% respectively following the implementation of case payment system. There is clear evidence that provider did shift cost to outpatient services during the first post-operative month (p＜0.05). The outcomes indicators such as re-admission, re-operation, complication, and prolonged hospitalization were indistinguishable between two groups (p＞0.05).
CONCLUSION: The implementation of case payment system proved to be effective to enhance efficiency of the practice of adult tonsillectomy by reducing length of stay. However, the impact of payment system to the surgical outcomes may require continuous monitoring to enhance healthcare quality.

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 ； 術後併發症

並列摘要

BACKGROUND: Using National Healthcare Insurance Database, we investigate the impacts of case payment system on medical expenses, outcomes and utilization for adult tonsillectomy.
METHODS: A total of 2,099 adult patients with chronic tonsillitis who underwent tonsillectomy during the period from March, 1998 to March, 2000 were identified. Surgical outcomes, medical resource utilization, and healthcare expenses were compared between groups of patients who were operated before (1,022 patients) and after (1,077 patients) the implementation of tonsillectomy case payment system on March 1999. Analyses were conducted using t-test and Chi-square test.
RESULTS: The average length of stay was shorten by 0.7 days (p＜0.05), and the total claimed amount was increased by 1.5% in average, but claimed medication fee, operation fee, and ward fee were reduced by 25.1%, 11.9%, and 10.4% respectively following the implementation of case payment system. There is clear evidence that provider did shift cost to outpatient services during the first post-operative month (p＜0.05). The outcomes indicators such as re-admission, re-operation, complication, and prolonged hospitalization were indistinguishable between two groups (p＞0.05).
CONCLUSION: The implementation of case payment system proved to be effective to enhance efficiency of the practice of adult tonsillectomy by reducing length of stay. However, the impact of payment system to the surgical outcomes may require continuous monitoring to enhance healthcare quality.

並列關鍵字

tonsillectomy ； case payment system ； medical resource utilization ； surgical complication