The Bureau of National Health Insurance yesterday announced that Diagnosis Related Groups (DRGs) will be formed from Sept. 1, but doctors expressed concern that they could lead to patients receiving inadequate care.
DRGs are a new policy that determines how National Health Insurance covers a patient’s expenses while in hospital.
DRGs provide a way of relating the type of patients treated by a hospital to the costs incurred by the hospital. Groups of patients have similar demographic, diagnostic and therapeutic attributes that determine the resources they need.
The process of fully implementing DRGs is expected to take six years. When the new policy is launched on Sept. 1, a total of 111 categories will be established.
The bureau said that another 856 categories would be completed by the end of the six-year period.
“DRGs will help us avoid unnecessary waste of medical resources,” said Tsai Shu-ling (蔡淑鈴), manager of the bureau’s Medical Affairs Section.
“With the new policy, hospitals will be able to avoid unnecessary waste and offer more efficient help and medical treatment,” Tsai said.
She said that under the current system, many patients spend time in hospital waiting for check-ups or surgery. The National Health Insurance has to cover all the expenses for hospital stays, even though patients are often waiting to see a doctor or receive treatment.
“If we pay the same amount to a hospital no matter whether the patient stays for one day or one week, the hospital, of course, will speed up their work and treat the patient as soon as possible. This is the idea behind the new policy,” Tsai said.
Doctors, however, expressed concern over the new policy.
“Say a patient develops pneumonia, high blood pressure and diabetes at the same time. Under the new policy, it is possible that the bureau will not pay the necessary expenses for high blood pressure and diabetes if the patient only fits one category, according to the prescription by the doctor,” said Wu Der-lang (吳德朗), chairman of the Taiwan Hospital Association.
Wu said hospitals may refuse to treat patients with multiple illnesses, or will ask the patient to undergo treatment for one illness, check out of hospital, and then re-register for the second illness.
“If the hospital does not do this, it will not be able to receive extra reimbursement from the bureau,” Wu said.