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Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data

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Authors
Kim, Hongsoo; Cheng, Shou-Hsia; Yamana, Hayato; Lee, Seyune; Yoon, Nan-He; Lin, Yi-Chieh; Fushimi, Kiyohide; Yasunaga, Hideo
Issue Date
2021-07-13
Publisher
BMC
Citation
BMC Health Services Research. 2021 Jul 13;21(1):694
Abstract
Background
Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems.

Methods
We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death.

Results
The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries.

Conclusion
There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.
ISSN
1478-4505
Language
English
URI
https://hdl.handle.net/10371/174819
DOI
https://doi.org/10.1186/s12913-021-06621-y
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Graduate School of Public Health (보건대학원)Dept. of Public Health (보건학과)Journal Papers (저널논문_보건학과)
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