實施全民健康保險住院診斷關聯群支付制度對醫療機構之影響

Objectives: The aim of this study was to determine the impact of the Taiwan Diagnosis Related Groups (Tw-DRGs) payment system on medical institutions with respect to medical expenses and quality of care. Methods: Inpatient-related data were obtained from the National Health Insurance research database (NHIRD) during the study period (2008-2011). Propensity score matching (PSM) was used to divide the subjects into DRG and non-DRG groups and differentiate the subjects according to the medical institutions at which they were treated. The difference-in-difference approach and the generalized estimating equation (GEE) model were used to compare the DRG and non-DRG groups with respect to changes in health care efficiency before and after the introduction of Tw-DRGs and to evaluate the impact of Tw-DRGs on medical institutions. Results: After Tw-DRGs were implemented, the DRG group had lower medical expenses, a lower inpatient transfer rate, and a lower mortality rate within 180 days after discharge compared to the non-DRG group. In contrast, after Tw-DRGs were implemented, the DRG group had a higher readmission rate within 180 days after discharge compared to the non-DRG group. Conclusions: After implementing the Tw-DRGs payment system, the medical expenses, mortality rate within 180 days after discharge, and inpatient transfer rate had decreased, but the readmission rate within 180 days after discharge had increased. We suggest that the NHI should continue monitoring medical institutions to ensure high-quality medical care, and the measurement of indicators, such as the readmission rate, should be more strictly and precisely defined.