The impact of case payment system on the utilization of vaginal delivery under national health insurance in Taiwan - Using data in a non-for-profit medical center

Objectives: It has been demonstrated in literature that Case Payment System (CPS) could control the growth of health expenditures effectively in comparing with Fee-for-service (FFS). Taiwan National Health Insurance (NHI), implemented in March 1995; therefore soon dedicated the adaptation of CPS for vaginal delivery and cesarean section reimbursement in the same year. We want to investigate if it was indeed the case in Taiwan. Methods: This study compared the changes in resource utilization at a medical center hospital from January to December 1994 and from May 1995 to April 1996. There were 4234 vaginal deliveries categorized as the FFS group, prior to the NHI implementation, and 4480 deliveries as the CPS group after the CPS implementation. Results: In the CPS group, the average medical expenditure and average length of maternal postpartum stay (MPS) decreased 6.4% and 12%, respectively compared to the FFS group. A reduction of MPS from 3.4 days to slightly over 3 days was possibly in response to MPS standards set by the NHI CPS program. However, there was a 21% increase in medication expenditures during maternal stay in the hospital. We suspect that this new system modified obstetricians' prescribing patterns in order to discharge patients early. Clinical exam and lab test expenditures also decreased; these expenses seemed to be shifted to outpatient care prior to admission. Conclusions: CPS may indeed contain medical expenditure. Furthermore, it is possible to induce physicians' practice behavior if the policy is precise and reasonable. However, we believe that the NHI CPS program has to establish minimum requirements standard for ensuring service quality and avoiding the possible behavior deviation of physicians in response to the new reimbursement scheme.