Impact of Reimbursement for the Amplatzer Septal Occluder under the National Health Insurance in Taiwan

Background: Transcatheter closure of secundum-type atrial septal defect (ASD) is currently a standard procedure in medical treatment. In Taiwan, medical care is covered for most people by the National Health Insurance (NHI). The aim of this study was to investigate the change in costs, patient numbers, and the quality of care before and after reimbursement for the Amplatzer septal occluder (ASO). Methods: In this retrospective time series survey, we searched the National Health Insurance Research Database (NHIRD) of Taiwan from 1996 to 2007. Files of inpatient expenditures by admissions were analyzed. The patient numbers, age, comorbidity, lengths of stay and costs were retrieved for analysis. Results: After review of records from 1996 to 2007, we noted that the cases of transcatheter closure dramatically increased in 2004 after NHI began covering the,fee for the ASO. However, when the cost of surgery increased 50% during the study period, the transcatheter approach had a 20% reduction of cost. The total expenditure for treating secundum-type ASD increased more than 4 times. The average length of stay decreased from 14.9 days in 1996 to 4.2 days in 2007. Conclusion: In conclusion, when a new minimally invasive technology was introduced into a closed system, patient numbers surged for a short period of time because more patients with uncomplicated heart disease were willing to undergo intervention. The length of stay was dramatically shortened and costs were reduced for individual patients in a basically fee-for-service system.