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APHA Scientific Session and Event Listing

Recorded presentation

Yue-Chune Lee, DrPH, Institute of Health and Welfare Policy, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei city, Taiwan and Chien-Ching Li, MPH, School of Public Health, Community Health Sciences Division, University of Illinois at Chicago, 3001 South Dr. Martin Luther King Jr Drive, Atp. 708, Chicago, IL 60616, 17735122067, cli6@uic.edu.

Introduction: To implement Case Payment Initiative the Bureau of National Health Insurance (BNHI) has developed Taiwan Diagnosis-Related Groups (T-DRGs) based on CMS DRGs with modifications. The International Refined-DRGs (IR-DRGs) were designed based on international data (vs U.S.), general population (vs elderly) and have better severity adjustment. The objective of this study is to compare the performance of IR, T- and CMS DRGs, in a context of closed-staff system.

Methods: Complete census of 6.67 millions inpatients claim data from 2001-3, DRGs and T-DRGs codes were obtained from BNHI. Cost per admission, including physician fees, and length of study (LOS) were the resources variables. Data were checked, cleaned and adjusted by uniform Fee Schedules, outliers were trimmed at 2.5 and 97.5 percentile. IR 1.2 were coded by CaseMix Expert software.

Results: (1) Number of DRGs were 901,958 and 492 for cost and 909, 962 and 493 for LOS, R2 (cost) were 0.52, 0.51, 0.47; R2 (LOS) were 0.32 0.28 and 0.29; percent of DRGs with coefficient of variation (CV)>100 (cost) were 12.47%, 16.2% and 18.9%, and 0.66%, 0.31% and 0.00% for LOS, respectively for IR, T- and CMS DRGs. (2) Except for a few Major Diagnosis Categories, IR outperformed T- and CMS DRGs within each MDC in regard to R2 and CV. (3) The financial impacts of the three DRGs system were similar and were greatest on medical center hospitals (-10.3~-10.8%) and public hospitals (-6.6~-7.6%).

Conclusion: IR is applicable in a closed-staff system, and outperformed T- and CMS at most circumstances.

Learning Objectives:

• Recognize the performance of IR-DRGs, T-DRGS and CMS DRGs in a closed-staffed system, which incorporate physician payment with hospital payment.
• To prioritized the choices among types of DRGs to be used for payment system reform.
• Recognize the possible financial impacts of DRGs on different type of hospitals.

Keywords: Health Care Reform, National Health Insurance

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation