Page 185 - 臺大管理論叢第33卷第1期

NTU Management Review Vol. 33 No. 1 Apr. 2023

regression on hospital charges is also negative, but is not statistically significant. This is
consistent with the results from Model 7 of Table 4 in that although hospital charges are
significantly higher before the CPs’ implementation within the GS division, the differences
are not significant when comparing the GS-ACP group with the ENT group.

4. Discussion

This study explicitly controls for the factors of patient-related, disease-specific, and
surgeon-associated characteristics to examine the effects of CPs on medical resource
utilization in terms of Length of Stay (LOS) and medical expenses. To be specific, the
length of stay for the GS division that adopted CPs decreases from 3.73 days to 2.54
days according to the descriptive statistics, which is also significantly lower than the

corresponding figure of 5.383 days for the ENT division without implementing CPs.
Moreover, the empirical results from the regression analysis that controls for other factors
demonstrate that the implementation of CPs can effectively reduce LOS and hospital
charges.

The findings of this study are consistent with previous research. For example, several
studies have indicated that CPs have shortened the LOS by 1.9-3.3 days in Singapore and
by 10.56-14 days in Japan (Kulkarni, Ituarte, Gunderson, and Yeh, 2011; Yang, Hu, Zhang,
Cao, Li, Wang, Shao, and Xin, 2016). Furthermore, although one study conducted in the

United States reports that thyroidectomy-related CPs did not reduce the LOS (Kwon et
al., 2018), most other studies agree that implementing CPs can effectively lower the LOS
(Kulkarni et al., 2011; Yang et al., 2016).
In addition, our results are in agreement with studies conducted in other countries that

have found that implementing CPs reduces hospital charges for some surgical procedures
such as those that are gastric- (Seo, Song, Jeon, and Park, 2012), colorectal- (Feroci,
Lenzi, Baraghini, Garzi, Vannucchi, Cantafio, and Scatizzi, 2013), orthopedic- (Ayalon,
Liu, Flics, Cahill, Juliano, and Cornell, 2011), and thoracoscopic-related (Schwarzbach,

Rössner, Schattenberg, Post, Hohenberger, and Ronellenfitsch, 2010). Besides, further
investigation on the fee items shows that the greatest reduction after implementation of
the CPs is the medicine fee, which could primarily be explained by the NHIA definition
of thyroidectomy as being a type of clean-wound surgery. More elaborately, in the GS

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