Original Article: The impacts of DRG payment system on financial balance of multiple trauma: Experiences of three trauma centers in Taiwan

• Published in: Injury 2023-09, Vol.54 (9), p.110703-110703, Article 110703
• Main Authors: Wu, Chao-Ying, Chien, Li-Chien, Lin, Chen-Chiang, Ma, Huei-Ming, Hu, Rey-Heng, Chen, Ching-Lin, Lin, Tzu-Hsin
• Format: Article
• Language: English
• Subjects: Diagnosis-related groups; Injury severity score; Multiple trauma; Revised trauma score
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.03.031

•Our study suggests the need of improvement for current design of MDC-24/DRG system in Taiwan.•Disease severity (ISS, RTS, and AIS) should be taken into consideration for the grouping of DRG, and supplementary payments should be introduced for longer ICU stay and operation time.•National trauma data bank should be established and be integrated with financial data to adjust the DRG payments regularly. There are concerns regarding the adequacy of applying the diagnosis-related groups (DRG) payment system for multiple traumas (i.e., major diagnostic category 24, MDC-24) patients in Taiwan. Therefore, this study used a multi-center dataset to assess the influence of the DRG payment system on the cost and outcome of multiple trauma care. We collected data of all multiple trauma patients from the Trauma Registry of three hospitals from 2014 – 2017. Next, we selected patients who met the criteria of MDC-24 and calculated the corresponding DRG payment. Subsequently, we combined the clinical care information with health insurance information to analyze the problems of applying the DRG payment system to multiple trauma care. Overall, of 465 cases, 367 met the criteria of MDC-24, and the mean injury severity score (ISS) was high (average 20.1). The total deficit of the polytrauma DRG cases amounted to 131,445 USD, and the average deficit in each case was 397 USD. In the multivariable analysis, higher revised trauma score and specific lower abbreviated Injury Scale (AIS) scores in certain body regions resulted in profits, while increased length of stay in intensive care units, longer operative time, and higher AIS score in the thorax were significantly correlated with deficits in medical costs. Our study revealed that the current DRG payment system results in financial losses for hospitals. Further, the payment grouping of MDC-24 should consider adding more disease severity factors to reduce the financial constraints faced by trauma centers.