The Impact of Disease-Specific Care Certification on Total Medical Costs for Joint Replacement Surgeries.

Abstract

Background/Objectives: This study investigates the impact of Disease-Specific Care Certification (DSCC) on total medical costs associated with joint replacement surgeries in Taiwan. Methods: Using retrospective inpatient data from a regional hospital, we analyzed 660 cases of primary total knee replacement (DRG20903), total hip replacement (DRG20904), and unicompartmental knee replacement (DRG20905) classified under Taiwan's Tw-DRG system. The dataset covered a 24-month period before certification and a 17-month period after certification, allowing for a comparison of cost changes associated with DSCC implementation. Results: While total medical costs increased slightly following certification, the differences across DRG categories were not statistically significant. However, significant increases were observed in rehabilitation costs (all DRGs), surgical costs (DRG20904 and DRG20905), anesthesia costs (DRG20904), and injection-related costs (DRG20905), indicating increased investment in standardized postoperative care. In contrast, blood transfusion and special materials costs significantly decreased in DRG20905, possibly reflecting improved care coordination and resource optimization. Additionally, the proportion of patients with prolonged hospital stays (≥11 days) declined significantly, suggesting potential efficiency gains. Conclusions: These findings imply that DSCC may facilitate better resource allocation and clinical standardization without substantially increasing overall medical expenditures, offering valuable insights for hospital administrators and policymakers operating under global budgeting systems.