鼻中膈鼻道成形術論病例計酬制實施之影響評估

Background. The implementation of the case payment system has helped contain the continuously inflating healthcare expenditures in Taiwan. The objective of this study was to investigate the impacts of the case payment system on the practice of septomeatoplasty. Methods. A total of 314 patients who underwent septomeatoplasty at the Department of Otolaryngology, China Medical College Hospital between July, 1998 and October,1999 were enrolled in this study. Surgical outcomes, complications, patient satisfaction, medical resource utilization, and healthcare costs were compared between groups of patients who were operated on before (129 patients) and after (185patients) the implementation of the septomeatoplasty case payment system in March i999. Analyses were conducted by t test and chi-square test. Results. The success rate, complication rate, and patient satisfaction were indistinguishable between the two groups (p＞ 0.05).We found that the doctors' behavior Was significantly modified. Furthermore, many intravenous medications were replaced by oral prescriptions, and the average hospitalization was shorten by 05 day (p＜0.05). The total up-front admission cost was reduced by 12.1%. Conclusions. The implication of the case payment system has proven to be effective for enhancing the efficiency of the practice of SMP, and has resulted in a small magnitude of cost reduction. However, there was no evidence to show that this new payment system has improved quality of care for patients who underwent SMP.