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Accidents remain the sixth highest cause of death in Taiwan in the past nine years, and its resulting trauma is the major cause of death for citizens aged 12-44. Thanks to the National Health Insurance System (NHI) however, financial burdens of trauma care patients were eased.
In 2010, the NHI introduced a new payment mechanism, the Taiwan Diagnosis Related Groups (TW-DRGs) system. Phase 3 is expected to be carried out, with 654 new groups mainly trauma care related, significantly affecting patients’ rights to quality healthcare.
We systematically reviewed journals and publications in electronic databases and organized the materials according to their highlighted relations between trauma care and the DRG.
The following four issues are identified:
- The lack of specificity in diagnosis classification for complex trauma cases.
- An outdated injury severity scoring system ISS.
- Failure to tackle the poor patient referral system in Taiwan.
- The lack of funds for the TW-DRGs and low coverage for multiple significant trauma cases.
- Proposed solutions
To tackle these issues, the following policies are proposed:
- Addressing the lack of specificity: Reclassify MDC groups with the help of DRG specialists.
- ISS outdated: Replacing ISS with ICISS and detailed electronic documentation.
- Systematic flaws: Adjusting the registration system and patient referral system.
- Lack of funds: Adjusting premiums of the NHI, separating hospital fees and doctor fees, setting up independent application systems for the severely traumatized, and systemic reforms of the potentially biased censor mechanisms.
The current system has pros and cons, in between, we aim to seek balance between managing medical costs and safeguarding traumatized patients’ rights. By adopting a more detailed algorithm and organized system, we hope to create a fairer environment of trauma care that benefits both doctors and patients.
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107年死因統計結果分析 (death statistics of 2018). Taipei, Taiwan: Ministry of Health and Welfare; 2018.
Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23:74.
2017-2018全民健康保險年報(2017-2018 National Health Insurance Annual Report). In: Administration NHI, editor. No. 140, Sec. 3, Hsinyi Road, Taipei 10634, Taiwan, R.O.C.: Po-Chang Lee; 2017.
詹孟樵, 李伯璋. 如何在落實醫療人權下有效利用健保資源--以健保鎖卡政策為例. 萬國法律. 2019(227期):頁64-74.
胡瑞恒 塗林簡. DRG 制度對於多重外傷醫療收支的影響. Taiwan Medical Journal. 2020;63(2):7.
Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma. 1998;44(1):41-9.
Lee YT, Lee YH, Kaplan WA. Is Taiwan's National Health Insurance a perfect system? Problems related to health care utilization of the aboriginal population in rural townships. Int J Health Plann Manage. 2019;34(1):e6-e10.
Copayment pricing. Taipei, Taiwan: Ministry of Health and Welfare; 2020.
Leong SH. Health Care for All: The Good & Not-So-Great of Taiwan's Universal Coverage. The News Lens 關鍵評論. 2018.
Huang Y-W. Research on the Correlation Causes of Health Insurance Review and Verification and the Success of Claiming. National Yunlin University of Science and Technology, Department of Industrial Engineering and Management. 2018:90.
Financial Statistics of the National Health Insurance System. Taipei, Taiwan: Ministry of Health and Welfare; 2020.
ICD-10-CM/PCS (TW-DRGs). In: Administration NHI, editor. 3.4 ed. No. 140, Sec. 3, Hsinyi Road, Taipei 10634, Taiwan, R.O.C.2020.
DerSarkissian C. Understanding Bone Fractures: the Basics. WebMD. 2020.
Osler T, Rutledge R, Deis J, Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma. 1996;41(3):380-6; discussion 6-8.
Jørgensen K. Use of the abbreviated injury scale in a hospital emergency room: potential for research in accident epidemiology. Acta Orthopaedica Scandinavica. 1981;52(3):273-7.
李卓倫. 如何配合總額預算分配落實分級醫療之研究. In: Ministry of Health and Welfare EY, editor. No.488, Sec. 6, Zhongxiao E. Rd., Nangang Dist., Taipei City 11558, Taiwan (R.O.C.)2004.
吳肖琪. 全民健保住院診斷關聯群制度對健康照護模式之影響評估(Evaluation of the Influence on the health care model caused by the Diagnosis Related Groups Payment System). 10353台北市大同區承德路二段46號3樓之3: Taiwan Long-Term Care Professional Association; 2014. p. 226.
Wu TY, Majeed A, Kuo KN. An overview of the healthcare system in Taiwan. London J Prim Care (Abingdon). 2010;3(2):115-9.
公醫時代. DRG遭反彈映照出的現況：台灣醫療預算不足、財務責任轉嫁醫師. The News Lens 關鍵評論. 2016.