兒童扁桃腺切除手術論病例計酬制實施之影響評估

Impacts of the Case Payment System on the Practice of Pediatric Tonsillectomy

王維吟(Wei-Yin Wang) ； 張燕良(Yen-Liang Chang) ； 王拔群(Pa-Chun Wang) ； 陳雅惠(Ya-Hui Chen)

《輔仁醫學期刊》 4卷2期 (2006/06) Pp. 73-81

摘要

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.

關鍵字

兒童扁桃腺切除手術 ； 論病例計酬支付制度 ； 醫療資源利用 ； 醫療品質

並列摘要

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.

並列關鍵字

pediatric tonsillectomy ； case payment system ； medical utilization