The analysis of the resource utilization for patients with thyroid cancer and benign thyroid diseases with thyroidectomy case payment
Objective: Based on the framework of HCFA DRGs, we conducted an analysis of the relationship between medical expenditures and the number of hospital days in patients who undergo thyroid surgery in Taiwan. It compares the differences in surgery for thyroid cancer and benign thyroid diseases, in relation to the two types of payment system and three levels of hospitals, in which these operations were performed. It is our hope that these findings will contribute to the design of the DRGs payment system in the immediate future. Method: Our data set utilizes claims data recorded by the Bureau of National Health Insurance (BNHI) for in-patients from March to December 1999. Subjects of interest were those who were admitted for thyroid surgery and were identified using the HCFA DRG 290 ICD-9 thyroid gland surgical codes. These subjects were then categorized into case payment and non-case payment groups, and further classified into cancer and non-cancer groups. Total health expenditures paid by the BNHI and the hospital days for each subgroup were evaluated. The differences were then determined according to the three levels of hospitals in which the procedure was performed. Results: A general trend prevailed in that thyroid cancer patients incurred greater hospital costs as well as longer days of hospitalization than benign diseases patients, whether the payment system was case payment or not. For the non-case payment subjects, the discrepancy in cost was evident in all hospitals, with the largest variation seen in the medical centers, reaching an average of NT$28,998. The predominant form (92%) of thyroid surgery performed in this country is for benign thyroid diseases. Conclusion: Based on our analysis, the consequence of HCFA DRGs design encourages biased patient selection by hospitals to operate on benign diseases, which leads to unnecessary surgery by promising better financial returns. The risk is thus shifted to hospitals which follow a more stringent surgical indication and treats a greater proportion of cancer patients. Such a payment system runs counter to promoting good surgical practice.
Wu, JY; Yeh, LL; Yen, KL; Huang, AT
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