Linkou Chang Gung Memorial Hospital (CGMH) performs hysteroscopy more often than other medical centers, the National Health Insurance Administration (NHIA) said on Tuesday, adding that 72 percent of the National Health Insurance payments for hysteroscopy in the past three years would be reclaimed.
Last week, the hospital management admitted medical negligence in an incident of intrauterine fetal death caused by performing hysteroscopy on a female patient without conducting a preliminary pregnancy test. The physicians involved the case were suspended for three months.
Hysteroscopy is a minimally invasive procedure during which a small tube-enclosed lighted camera is inserted through the cervix and into the uterus, allowing the physician to examine the inside of the uterus. It is often performed to diagnose and treat abnormal vaginal bleeding.
NHIA Director-General Lee Po-chang (李伯璋) on Tuesday said that after receiving a report about the case, the agency analyzed the data, and conducted on-site investigations and a medical professional review to understand what had happened.
The agency’s preliminary investigation showed that in the past three years, obstetrics and gynecology outpatient services at medical centers averaged about 550,000 visits each year, with Linkou CGMH accounting for about 80,000 cases, or 15 percent, Lee said.
Of about 18,500 hysteroscopy procedures performed per year at medical centers, Linkou CGMH accounted for about 8,800, or 47.4 percent of the national total, Lee said.
While on average 3.35 percent of obstetrics and gynecology outpatient patients underwent hysteroscopy at medical centers, the rate at Linkou CGMH was 10.5 percent, Lee said.
The administration commissioned specialists to conduct a review on 404 hysteroscopy cases performed by physicians that had the most cases and patients who received more than 10 hysteroscopies at Linkou CGMH over the past three years, Lee said.
It discovered that 291 cases, or 72 percent, had been unnecessary, unsuitable or redundant and the insurance payments for these cases in the past two years are to be claimed back, Lee said.
One patient was found to have undergone 25 hysteroscopies in the past three years, but specialists considered 20 of those to have been unnecessary, the agency said.
Performing hysteroscopy is not wrong, but as it is an invasive procedure, the hospital should have considered prescribing medication, ultrasonography or other procedures, Taiwan Association of Obstetrics and Gynecology secretary-general Huang Min-chao (黃閔照) said, adding that it should have conducted a pregnancy test before hysteroscopies.
Democratic Progressive Party (DPP) Legislator Lin Ching-yi (林靜儀), who is a gynecologist and obstetrician, said the NHI payment for performing a hysteroscopy is 2,034 points, but only 450 points for performing an ultrasonography, so whether the hospital performed so many hysteroscopies out of necessity for diagnosis or to earn extra insurance payments should be reviewed.
The NHIA suggested that the Taiwan Association of Obstetrics and Gynecology establish treatment guidelines for physicians to follow and urged patients to be vigilant about the health risks of invasive examination procedures.
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