Taiwan’s hospital payment cuts tied to stroke deaths
|
|
Cuts in reimbursement to hospitals made by Taiwan’s universal healthcare system in recent years may have slowed a decade-long decline in stroke deaths, hints a new study.
What the findings could mean for the U.S. and other countries wrestling with the question of how to control healthcare costs is unclear. But Taiwan’s experience might offer some wider lessons, the researchers say.
The study, published in the journal Stroke, found that from 1998 to 2007, the 30-day death rate among Taiwanese patients hospitalized for a stroke gradually declined—from 5.8 percent in 1998 to 3.7 percent by 2007.
However, changes in hospital reimbursements enacted in 2002—in an effort to control healthcare costs—may have put a brake on that progress, the researchers estimate.
Based on their analysis, every 1 percent decrease in average hospital net revenues from health-system reimbursements in a given year translated into a 1.2 percent increase in the 30-day death rate among stroke patients.
The 30-day death rate of patients with stroke in Taiwan “rose under increased financial strain from cuts in reimbursement,” wrote lead researcher Dr. Yu- Chi Tung, of Ming Chuan University in Taiwan and colleagues.
According to Tung’s team, cuts in reimbursements reduced hospitals’ overall net revenues by anywhere from 4.3 percent to 10 percent each year between 2002 and 2007.
The current findings do not prove that lower reimbursements directly affected stroke death rates. But it’s possible, the researchers say, that hospitals faced with reduced payments tried to lower their operating costs—by cutting services or reducing nursing staff, for example. That, in turn, could have affected the quality of patients’ care.
The study also found that other factors were key in stroke deaths, such as physician experience and hospital size. On average, for every 100 stroke cases a doctor had treated in the past year, a patient’s risk of dying within 30 days of a stroke declined by one-quarter.
But even with such factors considered, hospital reimbursements remained linked to stroke death rates.
The extent to which the findings have implications for other countries is not clear. Since 1995, Taiwan has had a single-payer universal healthcare system; in 2002, in an attempt to rein in healthcare costs, the country adopted a “global budgeting” system for hospitals.
All hospitals in Taiwan are on a fixed budget, Tung explained in an email to Reuters Health; each year, a “fee negotiation committee” comes up with an expenditure cap for all hospital care for the following year.
Tung noted that in the U.S., the 1997 Balanced Budget Act reduced Medicare reimbursements. Cuts to the government programs are also being proposed in the current healthcare reform debate.
However, a few studies have suggested that the 1997 cuts did not hurt hospital patients’ short-term survival after a heart attack or stroke. One study of Pennsylvania hospitals, for instance, found that while the hospitals’ revenues dipped in the few years after the Balanced Budget Act, 30-day death rates from stroke appeared unaffected.
A possible explanation, Tung and her colleagues say, is that the U.S. has well-established practice guidelines on the quality of stroke care—which may be maintained despite financial strains from reimbursement cuts, at least to an extent.
In Taiwan, the researchers note, national practice guidelines are still being worked out.
SOURCE: Stroke, online January 14, 2010.
Print Version
Tell-a-Friend comments powered by Disqus
