Background and Purpose: In this study, we investigated the impacts of implementation of a case payment system on the quality and medical utilization of pediatric (under 16 years old) tonsillectomies by analyzing the National Healthcare Insurance Database (1998~2000).Methods: In total, 491 pediatric patients were identified with tonsil hypertrophy or chronic tonsillitis who underwent a tonsillectomy during the period from March 1998 to March 2000. Surgical outcomes, utilization of medical resources, and healthcare expenses were compared between groups of patients who were operated on before (224 patients) and after (267 patients) implementation of the case payment system for tonsillectomies. Analyses were conducted using t-test and Chi-square test. Results: The average length of stay was shortened by 0.6 days (p<0.05). Except for the lab test, anesthesia, and operation fees, most of the other service item claims were remarkably reduced. The ward fee and medication fee were most significantly reduced (p<0.05), but there was no clear evidence to show that providers shifted costs to outpatient services. The outcomes index, such as readmission, reoperation, complications, and prolonged hospitalization were indistinguishable between the 2 groups (p>0.05). Conclusion: The implementation of a case payment system proved to be effective in enhancing the efficiency of the practice of pediatric tonsillectomy by reducing the length of stay. However, determining the impact of the case payment system on surgical outcomes may require continuous monitoring to enhance healthcare quality.
Background and Purpose: In this study, we investigated the impacts of implementation of a case payment system on the quality and medical utilization of pediatric (under 16 years old) tonsillectomies by analyzing the National Healthcare Insurance Database (1998~2000).Methods: In total, 491 pediatric patients were identified with tonsil hypertrophy or chronic tonsillitis who underwent a tonsillectomy during the period from March 1998 to March 2000. Surgical outcomes, utilization of medical resources, and healthcare expenses were compared between groups of patients who were operated on before (224 patients) and after (267 patients) implementation of the case payment system for tonsillectomies. Analyses were conducted using t-test and Chi-square test. Results: The average length of stay was shortened by 0.6 days (p<0.05). Except for the lab test, anesthesia, and operation fees, most of the other service item claims were remarkably reduced. The ward fee and medication fee were most significantly reduced (p<0.05), but there was no clear evidence to show that providers shifted costs to outpatient services. The outcomes index, such as readmission, reoperation, complications, and prolonged hospitalization were indistinguishable between the 2 groups (p>0.05). Conclusion: The implementation of a case payment system proved to be effective in enhancing the efficiency of the practice of pediatric tonsillectomy by reducing the length of stay. However, determining the impact of the case payment system on surgical outcomes may require continuous monitoring to enhance healthcare quality.