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Association between physician volume and hospitalization costs for patients with stroke in Taiwan: a nationwide
Herng-Ching Lin1, Sudha Xirasagar, Chi-Hung Chen
1School of Health Care Administration and the Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan.
Insights
Higher physician case volume in stroke care is linked to lower costs. Treating stroke patients with high-volume physicians could significantly reduce healthcare expenses, confirming an inverse volume-cost relationship.
Area of Science:
- Health Economics
- Neurology
- Healthcare Management
Background:
- Previous research indicates an inverse relationship between physician procedure/diagnosis volume and healthcare costs.
- Limited data exists on this volume-cost relationship specifically within stroke care.
Purpose of the Study:
- To investigate the association between physician case volume and per-discharge costs for stroke patients.
- Utilize nationwide population-based data to analyze stroke care costs in relation to physician expertise.
Main Methods:
- Analysis of 83,748 stroke hospitalizations in Taiwan (2004) involving 3757 physicians.
- Hierarchical linear regression modeling adjusted for patient, hospital, and physician variables.
- Categorization of physician case volume into low (1-44), medium (45-135), and high (>=136) groups.
Main Results:
- Unadjusted mean costs were highest for low-volume physicians (NT $79,993) and lowest for high-volume physicians (NT $43,942).
- Adjusted analysis revealed low-volume physicians incurred NT $27,729 more per case than high-volume physicians.
- Medium-volume physicians incurred NT $7761 more per case than high-volume physicians.
Conclusions:
- The study confirms an inverse volume-cost relationship in stroke care within Taiwan.
- Potential cost savings of 41.0% are achievable if all stroke patients are treated by high-volume physicians.
- Optimizing physician case volume could lead to substantial reductions in stroke treatment costs.
Background And Purpose:
Past studies consistently show an inverse relationship between physicians' surgical procedures/diagnoses volume and cost. There is little information available on this aspect of stroke care. We used nationwide population-based data to explore the association between physician case volume and costs per discharge for patients with stroke.
Methods:
Data on all 83,748 hospitalizations for stroke in 2004, treated by 3757 physicians in Taiwan, from Taiwan's National Health Insurance Research Database, was analyzed using hierarchical linear regression modeling to explore associations between costs per discharge and physician case volume (one to 44 cases=low volume, 44 to 135=medium volume, > or =136 cases=high volume) adjusting for patient's age, gender, comorbidities, and stroke type; hospital ownership, teaching status, and geographic region; and physician demographics.
Results:
Unadjusted mean cost per discharge was highest for patients treated by low-volume physicians, at NT $79,993 compared with NT $78,588 for medium-volume physicians and NT $43,942 for high-volume physicians (P<0.001). Adjusted for patient, hospital, and physician variables, low-volume physicians had a mean case cost of NT $27,729 higher than high-volume physicians (P=0.001) and NT $7761 higher than medium-volume physicians (P=0.027).
Conclusions:
Our data confirm an inverse volume-cost relationship for stroke care in Taiwan. After adjusting for patient, hospital, and physician characteristics, the potential cost savings if all patients were treated or supervised by high-volume physicians could be 41.0% of the mean treatment cost incurred by low-volume physicians.
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