Variable | Operational definition |
---|---|
Sex | Male or female. |
Age | Based on the World Health Organization definition and divided into dependent and non-dependent populations for a total of four groups: teenagers, 18–24 years; young adults, 25–44 years; adults, 45–64 years; and older adults, 65 years or above. |
Diagnosis code | Inpatient diagnosis based on the declaration of inpatient payment regulated by the Bureau of National Health Insurance (BNHI); one principal diagnosis and four secondary diagnoses max. Total number of diagnoses. |
Procedure code | Procedure based on the declaration of inpatient payment regulated by the BNHI; one principal procedure and four procedures maximum. Total number of procedures. |
DRG fixed cost (R) | 1. Tw-DRGs fixed payment = relative weight (RW) × standard payment rate (SPR) × (one basic treatment weight + pediatric weight + CMI weight + hospitals in mountainous region and offshore island weight) 2. Verification declaration for the lower limit of payment 3. Upper limit of payment = Tw-DRGs fixed payment*0.8 |
Estimated medical cost (R 1 ) | Total costs calculated by the corresponding NHI payment standard for treatment provided. |
Cost difference (∆R) | Fixed cost, R – estimated medical cost, R 1 |
Ratio of cost difference over fixed cost (∆R/R) | (Fixed cost, R – estimated medical cost, R 1 )/DRG fixed cost |