The purpose of this study was to assess the adequacy of the third version of Tw-DRGs. The adequacy was determined by calculating the coefficient variation (CV) and the coefficient of determination (R2) of the charges and lengths of stay (LOS). The research data were derived from the 2006 National Health Insurance Research Database of the National Health Research Institute.
This research found (1) For both the charges and LOS of 827 DRGs, the overall charge explanation value is 0.395 and LOS explanation is 0.714. There are significant negative correlations between CV and R2?? (p<0.01) for both the charge and LOS. ?2?The individual DRG explanation could be used as the reference for future Tw-DRG version revised. (3) How to increase the charge explanation values for MDC4, MDC10, and MDC17 is needed, as there are all below 0.2. (4) To increase the charge explanation value, the third version DRGs adjusted and reclassified the three lowest groups in the first version, however, it was only increased to about 0.3; more suitable classification logic is needed for future revision.
Suggestion: (1) Although Tw-DRGs is postponed for implementation at present, we should focus on the low DRG explanation to make the revision, enable it to provide a reasonable payment and more reasonable assignment of medical resources in the future version. (2) After the Tw-DRGs versions are revised, it should be possible to increase the CC level and present the actual disease severity. Hence, there is reasonable payment and wasted resources are avoided. (3) Taiwan should establish an independent institution for medical service investigation. This independent institution would be responsible for appropriate surveillance of medical services provided by the medical service insurance organization to protect the rights of people asking for medical care.
