Impact of Cuts in Reimbursement on Outcome of Acute Myocardial Infarction and Use of Percutaneous Coronary Intervention

A Nationwide Population-based Study Over the Period 1997 to 2008

Bibliographic Data

ID9102255
AuthorsGuann-Ming Chang (Cardinal Tien Hospital, corresponding author), Simon H Cheng (0000-0001-7630-9934, National Taiwan University), Shou-Hsia Cheng, Yu-Chi Tung, Yu‐Chi Tung (0000-0001-9031-8749, Ming Chuan University)
Year2011
Volume49
Issue12
Pages1054-1061
Publication date2011-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e318235382b
PMID22009149
OpenAlexW2320894191
LanguageEN
Citations received2
References cited33

BACKGROUND: The impact of cuts in reimbursement, such as the Balanced Budget Act in the United States or global budgeting, on the quality of patient care is an important issue in health-care reform. Limited information is available regarding whether reimbursement cuts are associated with processes and outcomes of acute myocardial infarction (AMI) care. OBJECTIVES: We used nationwide longitudinal population-based data to examine how 30-day mortality and percutaneous coronary intervention (PCI) use for AMI patients changed in accordance with the degree of financial strain induced by the implementation of hospital global budgeting since July 2002 in Taiwan. METHODS: We analyzed all 102,520 AMI patients admitted to general acute care hospitals in Taiwan over the period 1997 to 2008 through Taiwan's National Health Insurance Research Database. Multilevel logistic regression analysis was performed after adjustment for patient, physician, and hospital characteristics to test the association of reimbursement cuts with 30-day mortality and PCI use. RESULTS: The mean magnitude of payment reduction on overall hospital revenues was highest (10.02%) during the period 2004 to 2005. Large reimbursement cuts were associated with higher adjusted 30-day mortality. There was no statistically significant correlation between reimbursement cuts and PCI use. CONCLUSIONS: The mortality of AMI patients increases under increased financial strain from cuts in reimbursement. Nevertheless, the use of PCI is not affected throughout the study period. Reductions in the quantity or quality of services with a negative contribution margin or high cost, such as nurse staffing, may explain the association between reimbursement cuts and AMI outcome

Conventional PCI · Environmental health · Health care · Myocardial infarction · Percutaneous coronary intervention · Population · Reimbursement · Staffing · Emergency Medicine · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Internal Medicine · Medicine · Nursing · Primary Care and Health Outcomes

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