Graduate School of Public Health Department of Public Health Science, Institute of Health and Environment, & Institute of Aging, Seoul National University, Seoul, 08826, South Korea.
Institute of Health Policy and Management, College of Public Health, Population Health Research Center, National Taiwan University, Taipei, Taiwan.
BMC Health Serv Res. 2021 Jul 13;21(1):694. doi: 10.1186/s12913-021-06621-y.
Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems.
We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death.
The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries.
There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.
东亚地区髋部骨折住院治疗情况鲜为人知。本研究考察了与日本、韩国和中国台湾地区髋部骨折手术实施相关的患者、医院和地区特征。我们还分析并比较了各卫生系统中指数医院的资源利用情况和短期治疗结果如何因各自卫生系统中的因素而有所不同。
我们采用通用协议，通过开发可比的、覆盖全国家庭医疗保险索赔数据的个体水平数据集，并与医院和地区水平的统计数据进行关联，从而建立了这三个卫生系统。我们对住院时间（LOS）和指数住院总费用以及住院内死亡进行了广义线性多层分析。
大多数患者为女性，年龄在 75 岁及以上。日本、韩国和中国台湾地区髋部骨折手术住院的标准化 LOS 分别为 32.5（S.D. = 18.7）天、24.7（S.D. = 12.4）天和 7.1（S.D. = 2.9）天。各系统的入院总费用也存在较大差异。所有三个系统中，髋部骨折手术量较高的医院 LOS 较低，而 LOS 和总费用的其他相关因素在国家之间存在差异。
东亚地区具有相似社会医疗保险计划的三个卫生系统中，指数医院髋部骨折手术的资源利用存在较大差异。需要进一步深入调查这些巨大差异，并努力克服国际卫生系统绩效比较的方法学挑战。
