Page 188 - 臺大管理論叢第33卷第1期

The Effect of Applying Clinical Pathways on Medical Resource Utilization among Patients Undergoing a
Thyroidectomy

This in turn has minimized variations among patients during the treatment process and has
effectively brought costs under control, thereby reducing hospital charges.
The results of the multivariate regression reveal that age and CCI have significant
effects on LOS and hospital charges. In the current study, patient age has a non-linear

effect on medical resource utilization, indicating that children or elder patients consume
more medical resources, which is in agreement with previous studies (De Nardi, French,
Jones, and McCauley, 2016). This may be due to the reason that elder patients are more

likely to develop a more severe course and progression of the disease, which complicates
medical conditions and increases the need for medical care resources. Another reason
may be attributed to the fact that physicians tend to provide more preventive treatments
when facing high-risk patients. Moreover, this study finds that LOS and hospital charges
increase with comorbidities, which is in line with the findings of the previous literature.

For example, a review on medical resource utilization suggests that granting patients the
status of having developed a major illness significantly affects their LOS and hospital
charges (Younossi, Otgonsuren, Henry, Arsalla, Stepnaova, Mishra, Venkatesan, and

Hunt, 2015). In addition, related studies have also found that an increase in the number of
secondary diagnoses results in increases in interventions, hospitalization days, and hospital
charges (McPhail, 2016).
However, other control variables such as gender, the diagnosis factor, intervention
methods and surgeon-related characteristics do not significantly influence the LOS

and hospital charges. For instance, a study conducted in the United States on hospital
charges for well-differentiated thyroid cancer treatment has found that hospital charges
among female patients are higher than those among male patients (Lubitz et al., 2014).

Conversely, the Statistics and Trends in Health and Welfare 2015 published in Taiwan by
the MHW indicates that hospital charges for male patients are on average 1.4 times higher
than those for female patients (Ministry of Health and Welfare, 2015). The discrepancies
in these findings suggest that the relationship between gender and medical resource
utilization may vary according to the disease.

Apart from gender, we also find that the intervention (surgical) types have no
significant influence on medical resource utilization. Studies on thyroid-related diseases
have pointed out that since surgical practices and equipment vary with each country, LOS

and hospital charges may also vary accordingly (Kwon et al., 2018). The insignificant

180