Abstract Since Mar. 1995, the National Health Insurance begin in Taiwan, the payment of health insurance gradually increase each year. For controlling the increasing costs, case payment was the most important method. For each hospital, using clinical pathway to control costs of case payment was an effective tool. But, there were still less literatures to discuss the efficiency of clinical pathway in Taiwan. We used a retrospective study design, to examine the length of stay, total costs and quality including the complications, morbidity and readmissions for total knee replacement surgery. The data before clinical pathway was from June 2001 to May 2002, total 219 cases. After clinical pathway, the data was from Jan. 2003 to Dec. 2003, total 207 cases. The results showed decrease length of stay from 7.4 to 6.6 days (10.8%), decrease total cost from 125,324 NTS to 119,100 NTS (4.97%) and the quality of complications and readmissions did not increase. In conclusion, the clinical pathway can improve length of stay, total costs and quality. Key words: case payment, clinical pathway, total knee replacement

Objective: Since its implication, case payment system prevailed and increased cases number in the following years. Hospitals in Taiwan face continous challenge with emerging policies such as global budget and TW-DRG system, which is soon on the way. Remarkable medical resource comsuption is seen in patients with congenital heart deseases, with presence of structural heart defects at birth. The corrective treatment of congenital heart diseases, surgical and transcather, is usually undertaken in large-scale Hospitals in Taiwan.Congenital heart diseases. Items of case payment for congenital heart diseases treatment were implented years ago. However, in the literature there is yet no research about the results of its implentation. This study focus on three objectives: 1.To study of medical resource consumption of case payment system with congenital heart diseases. 2.To study the effect of patient and provider attributes on medical resource consuption in the case payment with congenital heart diseases. 3.To provide the evidence-based information for forcoming NHI policies. Materials and Methods: Retrospectively, claims data from Bureau of National Health Research Insurance (BNHI) for resource utilization of case payment for congenital heart diseases was analyzed. The data includes DD(Inpatient expenditures by admissions) and HOSB(Registry for contracted medical facilities) files ranged from 1997 to 2005. Data items meeting the criteria of both CHD and case payment were extracted. The relationships between patient factors (age, sex, DRG code), healthcare provider (contract type, accreditation type, ownership, area) and resource utilization (length of stay, expenditure) were studied. Results: A total of 4,366 admissions for CHD case payment was enrolled. The mean patients¡¦ age is 14.56 years. Female accounts for 55.46 % of the admissions. Among them there are 3954 open heart surgeries and 412 transcatheter treatments. Average hospital day is 11.6 and 3.37 days respectively. Average payment per case is NT$215,355 and NT$61,819 respectively. Different degrees of resource utilization occur with different patient or hospital characteristics, with statistical signifcance. More resource utilization tends to occur in extremes of age groups, e.g., newborn and elderly populations, regardless open heart surgery or transcatheter treatment cases. Also more hospital fee occurred in private hospital than public hospital, but less in medical centers when compared to metropolitian hospitals. For regression analysis of dependence of resource consumption on patient and hospital factors, the overall power of explanation is higher in transcather treatment cases. Among the factors influencing medical resource utilization, age_group and ownership are respectively the most significant factors. Conclusion: We have verify the hypothesis in this study, which emphasize that resource utlization differs by different patient and hospital factors. The pattern of resource utilization for this unique disease (CHD) and its discrepancy with concurrent payment criteria are evaluated in this study. Based on our results, adjustment of payment criteria should be reasonable to ensure early and adequate treatment for these patients. Thus this study provides strong insight for implication of TW-DRG for disease management. Further study will include aspects of resource utlization such as direct, indirect costs, tangle and intangle, and related complication and comorbidities.

The rise of medical expenses is a common problem in the whole- wide world. All those countries implementing National Health Insurance have been anxiously looking for solutions, and clinical pathway has been found to be the most effective tool to control the growth of medical expense and maintain the quality of healthcare. This study focuses on the development and implementation of clinical pathway of breast cancer who underwent modified radical mastectomy, and investigate the impact of implementation of clinical pathway on the control of the length of stay, inpatient medical care expenditures, healthcare quality, and patient¡¦s medical satisfaction. The 90 patients of MRM before implementation ( July 1999 to Sep. 2000 ) and 80 patients after implementation ( Jan. 2001 to Feb. 2002 ) are taken as the targets of this study. The major findings of the study are listed as follows: 1. Clinical pathway can reasonably control the length of stay. 2. Clinical pathway can reduce inpatient medical care expenditures. 3. Clinical pathway can improve healthcare quality. 4. Clinical pathway can improve patient¡¦s medical satisfaction. 5. Clinical pathway can influence doctor¡¦s partial practice pattern. Finally this study concludes that clinical pathway is an instructive tool for hospital management. Based on the results and discussion from the study, we suggest the implementation of clinical pathway cones best in conjunction with the impact of case payment; besides, the quality of medical care should be assured under the controlled medical cost.

Objectives: Study wanted to explore the factors that will affect the total medical expense in the patients who receive laparoscopic cholecystectomy (LC). We also to confer the influencing factor that will associate with the difference of reports the expense under the case payment system. Methods:Retrospective study . Collected from year 2003 to 2007, received LC in a general teaching hospital in Kaohsiung city. We also adopt the chart review and combined with the health insurance expense data to explore the important factors that were associated with total hospitalized expenses, declaration of expense differences, and profits. The methods of multiple linear and logistic regressions were needed. Results: 1539 subjects, 613 male and 926 female. The average age was 54.4 , and 1313 subjects were hospitalized from outpatient. All subject¡¦s average hospitalized days were 3.79 and medical expenses were 42528.1 dollars. The frequencies of the type of declaration about ¡¥not exceed¡¦, ¡¥exceed but actually¡¦, and ¡¥exceed but no actually¡¦ were 88.8%, 8.6%, and 2.6%, in sequence. The average declaration of expense differences was 14484.1 dollars. The significant factors that were associated with total hospitalized expenses were the age, surgical year, source of hospitalize, major symptom, combine disease, a complication after surgery, hospitalized days, type of declaration. In the other linear regression model, we found the age, surgery year, source of hospitalize, major symptom, high technology examination before surgery, combine disease, a complication after surgery, hospitalized days, and physician¡¦s surgery quantity per year had been statistically significant with the declaration of expense differences. For the odds of hospital¡¦s profits, the significant factors include the surgery year, source of hospitalize, major symptom, high technology examination before surgery, and hospitalized days. Conclusion: We found a few significant factors that were associated with dependent variable in three regression models in this study. The major factor is hospitalized days that were a stronger influence total hospitalized expenses, declaration of expense differences, and hospital¡¦s profits. The hospital¡¦s superintendent can carry on the management through the appropriate method to control the medical resource consumes.