The changes in readmission rate within 30 days after total hip replacement before and after the implementation of a case-based prospective payment system

Objectives: The goals of this study are to investigate the changes in readmission rate within 30-day of THR (Total hip replacement)before and after the implementation of CPS (Case Payment System) and its related factors. Methods: The Bureau of National Health Insurance implemented the case payment for THR in November 1997. The outcome was analyzed according to the claimed database of national health insurance data of 2,550 patients with THR before CPS (from Jan 1997 to Oct 1997), and 11,884 patients with THR after CPS (from Jan 1998 to Nov 2000). Results: The 30-day readmission rates were 10.08% and 11.29% before and after CPS implementation. According to the logistic regression model, 30-day readmission rate increased significantly after the implementation of CPS (OR=1.31). This study revealed that being male, older, having more severity, LOS (length of stay) and in-hospital complications were found to be positively and significantly related to the 30-day readmission rate after THR. However it was negatively influenced by the medical centers, hospital and physician volume, and inpatient rehabilitation. Conclusion: The study found that the 30-day readmission rate significantly increased after implementing CPS. This effect should be noted. It is important to maintain medical quality when cost-control mechanisms are implemented. For example, NHI should monitor medical quality of hospitals and physicians with lower volumes.