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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

Chang, Guann-Ming MD, MS*; Cheng, Shou-Hsia PhD; Tung, Yu-Chi PhD

doi: 10.1097/MLR.0b013e318235382b
Original Articles

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.

*Department of Family Medicine, Cardinal Tien Hospital, New Taipei City

Institute of Health Policy and Management, National Taiwan University, Taipei

Department of Healthcare Information and Management, Ming Chuan University, Taoyuan County, Taiwan

The study is supported by grants from the National Science Council (NSC97-2410-H-130-011) in Taiwan, and is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of Bureau of National Health Insurance, Department of Health or National Health Research Institutes.

The authors decalre no conflict of interest.

Reprints: Yu-Chi Tung, PhD, Department of Healthcare Information and Management, Ming Chuan University, Room AA611, No. 5, De Ming Rd, Gui Shan District, Taoyuan County 333, Taiwan. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.