title: Impact of the case payment reimbursement method on the utilization and costs of laparoscopic cholecystectomy.
abstract: The purpose of this study was to examine the relationship between adoption of case payment for laparoscopic cholecystectomy (LC) and the growth rate of LC, outcomes of patients undergoing LC, and total healthcare expenditures on cholecystectomy. We used the claims data from Bureau of National Health Insurance (BNHI) to identify patients who underwent LC and open cholecystectomy (OC). Data were available from January 1996 to October 1997 and from January 1998 to October 1999, enabling use to compare data from before and after the introduction of the new case payment system. Results showed that the volume and the proportion of LCs increased after adoption of the new payment method. We did not find a sharp increase in the cholecystectomy rate during the study period. In terms of outcomes, the admission rate for emergencies decreased; the surgery mortality rate decreased, but the readmission rate increased. The average cost and length of hospital stay for LC subjects decreased; however, the total cost of cholecystectomy increased. The impact on LC of the introduction of a case payment method failed to reduce total health expenditures for cholecystectomy.
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, No. 155, Sec. 2, Li-Noon Street, Taipei 112, Taiwan, ROC. hclang@ym.edu.tw
authors.forename: Hui-Chu
authors.initials: HC
authors.lastname: Lang
authors.forename: Chunhuei
authors.initials: C
authors.lastname: Chi
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000300:Adoption; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011445:Prospective Payment System; D013624:Taiwan; D014600:Utilization Review