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Case Payment and the Adoption of New Technology:An Empirical Study of Cataract Surgery in Taiwan.

Author(s): Chorng-Jer Hwang | Lai-Chu See | Yi-Chou Chuang

Journal: Chang Gung Medical Journal
ISSN 2072-0939

Volume: 27;
Issue: 05;
Start page: 327;
Date: 2004;
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Keywords: extracapsular cataract extraction | phacoemulsification | case payment | adoption of new technology

Background: Case payment for cataract surgery with Government Employee Insurance(GEI) was implemented at Chang Gung Memorial Hospital (CGMH) inMarch 1994, and fee-for-service (FFS) was retained for cataract inpatientswith or without other health insurance. We examined the impact of thischange in the reimbursement policy from FFS to case payment on the healthcare provider's practice behavior towards a new emerging technology, usingcataract surgery as an example.Methods: Secondary data analysis was performed using 1 year of CGMH data before(period 1, from March 1993 to February 1994) and after (period 2, fromMarch 1994 to February 1995) implementing the new policy. Inpatientrecords for cataract surgery using either extracapsular cataract extraction(ECCE, the old technology) or phacoemulsification (Phaco, the new technology)were included. Logistic regression models were employed to assesshow case payment affected the health care provider's adoption of new technology.Results: The percentage of cases treated using the new Phaco technology grew fromperiod 1 (6.6%) to period 2 (23.6%) among all 4 study groups, despite Phacobeing more expensive than ECCE. More importantly, the increment ratio ofPhaco use from periods 1 to 2 was the smallest for GEI patients (3.26-fold)when compared with the other 3 groups (4.16-5.29-fold).Conclusions: Both new technology and cost containment strategies should be taken intoaccount when setting up a reimbursement policy.
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