Impact of drug-eluting stents balance billing on Recipients and Treatment Outcome

Rationale£º The Bureau of National Health Insurance authorized the "balance billing" in December 2006 for the reason to lower the growth rate of medical expenditures of National Health Insurance. The regulation has raised concerns about the potential adverse effects of allowing health care providers to bill health insurance beneficiaries for fee that are above health insurance reimbursements. Beneficiaries who are unable to afford the extra charges are concerned that the access to medical service would be compromised. Furthermore, does this payment system affect the quality of health care?

Objectives: To evaluate the correlation among drug-eluting stents balance billing and social economic status (S.E.S) and the correlation among drug-eluting stents balance billing payment system and risk-standardized, 7-day readmission rates, 3-day emergency department visit rates.

Design: Cohort study conducted by using hospital admission claim data.

Participants: A total of 8,886 recipients receipted drug-eluting stents (2,803 cases) or bare-metal stents (6,083 cases) in December 2006 to June 2007 in Taiwan.

Main Outcome Measures: Hospital readmissions and emergency department visits after discharge between the use of drug-eluting stents (need extra balance billing) and bare-metal stents (no need of extra balance billing) recipients.

Methodology: Charlson comorbidity Index were used as the proxy of patients' disease severity. Simple and multiple logistical regression models with generalized estimating equations (GEE) were used.

Results: After the implementation of balance billing payment system, the low-income beneficiaries had a significantly less likelihood to use the drug-eluting stents (OR=6.70; 95% CI: 2.94, 15.25; OR=6.21; 95% CI: 2.74, 14.09; OR=9.93; 95% CI: 4.36, 22.58;), compared with other beneficiaries whose monthly wage were Conclusions: In Taiwan, the implementation of drug-eluting stents balance billing especially effect on the low-income beneficiaries than other S.E.S beneficiaries. Furthermore, patients received drug-eluting stents had lower 7-day readmission rate and 3-day emergency department visit rate. Policies should focus on the most visible discrimination that exists among various income level beneficiaries and its effects on the treatment outcome.