300404
Impact of DRG payment on physicians and patients under Taiwan National Health Insurance
The aim of this study was to evaluate the impact of the Taiwan Diagnosis Related Groups (Tw-DRGs) payment system on the autonomy and compensation of physicians as well as the satisfaction of patients under universal insurance coverage in Taiwan.
Methods
Two mail surveys were sent to physicians and patients. Physicians who treated at least 36 inpatients during 2010 were questioned regarding their autonomy and compensation before and after the implementation of Tw-DRGs. Patients who were hospitalized between January and June 2012 were questioned about their satisfaction with medical services and out-of pocket expenses, compared to their previous experience as inpatients. According to DRG coding, all physicians and patients were assigned to DRG and non-DRG groups. Linear regression and logic regression were employed for data analysis.
Results
The number of physicians who completed the questionnaire were as follows: 749 (in the DRG group) and 761 (in the non-DRG group), representing response rates of 13.36% and 14.69%, respectively. Approximately half of the physicians reported that they were unaffected by the Tw-DRGs with regard to practice patterns, professional autonomy, and compensation. A number of physicians in the DRG group reported a loss in professional autonomy (43.1%) and reduced compensation (46.2%) following the implementation of Tw-DRGs.
A total of 3653 patients completed the questionnaire for a response rate of 7.23%. Among these, 1888 were in the DRG group and 1765 were in the non-DRG group. Individuals in the DRG group expressed greater satisfaction with their latest inpatient experience (under the DGR system) when contrasted with their previous inpatient experience (without the DRG system). Out-of pocket expenses were shown not to have increased after the implementation of Tw-DRGs. However, it is possible that patients were discharged earlier and the daily costs in hospitals may have risen. Patients in the non-DRG group revealed a higher risk of inappropriate discharge.
Conclusions
These results indicate that the implementation of Tw-DRGs payment did not affect practice patterns, professional autonomy, or compensation of physicians. Tw-DRGs were also shown not to have compromised patient satisfaction with medical care nor increased their out-of pocket expenses.
Learning Areas:
Provision of health care to the publicPublic health administration or related administration
Public health or related public policy
Public health or related research
Learning Objectives:
Evaluate measures taken to reform the DRG payment system of the National Health Insurance in Taiwan
Keyword(s): Health Care Reform, Health Insurance
Qualified on the content I am responsible for because: The study is designed by me and completed by all the co-authors listed on the abstract.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.