Reported by Chiang Hui-Chun from Taipei

The NHIA announced that the Diagnosis-Related Groups (DRGs) system is to be fully implemented in the in-patient sector from March.  About 2 million patients will be affected.  The NHIA believes that the DRGs system will help improve health professionals’ autonomy and reduce unnecessary hospitalization services.  However, health professionals worry that some severe cases may cause financial loss.  As a result, hospitals may charge patients for some costly treatments or even refuse to treat severe cases. 

The NHI used to reimburse by services.  This payment method has been criticized for wasting healthcare resources.  The NHIA started introducing the DRGs system in 2010 by setting a fixed payment for the treatment of each targeted disease.  Hospitals receive the same amount of payment for treating certain disease, regardless of treatment methods, medicines and the length of hospitalization.  The NHIA postponed the full implementation from January to March due to health professionals’ concerns over the welfare of severe cases.   The regulations have been revised, hence the delay.

Pang Yi-Ming of the NHIA pointed out that the DRGs system targets on patients who are fit to be discharged from hospitals after being hospitalized for under 30 days.  Severe cases, such as cancer patients, patients receiving organ transplant, patients with mental illnesses, are not included in the scope of the DRGs system.   The NHIA estimated that about 58% of the NHI spending on inpatient services will be subject to the DRGs system.

Dr Wei Zheng, the Director of the Cardiology Department of Cheng Hsin General Hospital, reckoned that the key point of the DRGs system is the payment price.  For example, some cases may cost more than the fixed price.   For those cases, hospitals will either lose money from treating patients or be criticized for rejecting patients.  Hospitals may resort to prematurely discharging patients for financial reasons. 

Dr Shih Jing-Chung from the Department of Obstetrics and Gynaecology of the NTUH expressed that under the DRGs system, each severe case is a financial burden.  The NHIA agreed to exclude severe O&G cases from the DRGs only after health professionals’ repeated appeals.

Pang Yi-Ming expressed that the NHIA has already further classified the service items under the DRGs system to increase the number of service items from 1062 to 1663.  Complicated and severe cases will be reimbursed at the actual cost.  Mortality cases and life-threatening cases are excluded from the DRGs system.

Sheng Pei-Han, a researcher of the Taiwan Healthcare Reform Foundation, pointed out that the DRGs system is a trend.  However, the NHIA should monitor hospitals and investigate any cases involving premature discharging.   So far, there are only 7 indexes for monitoring.  She suggested that the NHIA should automatically investigate hospitals with high re-admission rates.  Hospitals taking in more than average number of severe cases should be rewarded.

Pang Yi-Ming expressed that the NHIA’s “Hospital Discharge Service Plan” is ready for implementation.   Hospitals will receive money for carrying out case management and case follow-up services.   After the DRGs system is up and running smoothly, the NHIA will work out a system to reward hospitals for taking in severe cases.  The NHIA will also monitor patients’ rights by analysing the data collected from the NHI IC cards.

【2016-01-30/ United Daily News】