title: Case payment and the adoption of new technology: an empirical study of cataract surgery in Taiwan.
abstract: BACKGROUND
  Case payment for cataract surgery with Government Employee Insurance (GEI) was implemented at Chang Gung Memorial Hospital (CGMH) in March 1994, and fee-for-service (FFS) was retained for cataract inpatients with or without other health insurance. We examined the impact of this change in the reimbursement policy from FFS to case payment on the health care provider's practice behavior towards a new emerging technology, using cataract surgery as an example.
  
  
  METHODS
  Secondary data analysis was performed using 1 year of CGMH data before (period 1, from March 1993 to February 1994) and after (period 2, from March 1994 to February 1995) implementing the new policy. Inpatient records for cataract surgery using either extracapsular cataract extraction (ECCE, the old technology) or phacoemulsification (Phaco, the new technology) were included. Logistic regression models were employed to assess how case payment affected the health care provider's adoption of new technology.
  
  
  RESULTS
  The percentage of cases treated using the new Phaco technology grew from period 1 (6.6%) to period 2 (23.6%) among all 4 study groups, despite Phaco being more expensive than ECCE. More importantly, the increment ratio of Phaco use from periods 1 to 2 was the smallest for GEI patients (3.26-fold) when compared with the other 3 groups (4.16-5.29-fold).
  
  
  CONCLUSIONS
  Both new technology and cost containment strategies should be taken into account when setting up a reimbursement policy.
authors.affiliation: Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chorng-Jer
authors.initials: CJ
authors.lastname: Hwang
authors.forename: Lai-Chu
authors.initials: LC
authors.lastname: See
authors.forename: Yi-Chou
authors.initials: YC
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D001766:Blindness / Q000601:surgery; D002386:Cataract / Q000628:therapy*; D002387:Cataract Extraction / Q000191:economics*; D036262:Empirical Research; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000331:legislation & jurisprudence; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000191:economics* / Q000379:methods; D013624:Taiwan