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

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.

Variation in care for patients presenting with hip fracture in six high‐income countries: A cross‐sectional cohort study

“…32 In contrast, the low mortality observed in Taiwan is interesting and consistent with a recent study that found lower inpatient mortality for patients in Taiwan than in either Japan or Korea. 19 Second, despite an estimated 2.6 million hip fractures annually worldwide by 2025, there remains substantial uncertainty about which type of surgical repair a given patient should receive. 33 The choice of repair approach depends, in part, on the anatomy of the fracture (e.g., fixation for nondisplaced or intertrochanteric fractures versus THA or HA for displaced fractures of the femoral neck); age and functional status are also important considerations, with THA generally reserved for younger, healthier patients.…”

“…37,38 In contrast, the Taiwanese reimbursement system may not adequately incentivize surgeons and hospitals to perform THA and HA, resulting in higher rates of less complex fixation. 19 In the US, modest rates of THA and higher rates of IF may well reflect discordance between the high amount of surgeon effort required to perform THA relative to reimbursement. 39 In aggregate, the variation that we see likely reflects the more intentional design of hip fracture management programs and reimbursement models in certain countries combined with a lack of compelling data to generate strong international consensus on the best approaches.…”

“…Studies comparing hip fracture treatment across high-income countries are limited. Some were not nationally representative, 15,16 limited to a small number of countries, 15,[17][18][19] or relied upon aggregated data. 2,20 Moreover, many studies have not evaluated betweencountry differences in the repair procedure used.…”

Fragility Fracture Systems: International Perspectives - Asia & Australia

“…In Korea, most of hip fractures are managed in private hospitals (95.8% vs 4.2% of public) and in teaching hospitals (92.8%). [37] Incentive based funding for hip fractures does not exist nationwide in Korea, despite international evidence suggesting the benefit. [12] 3.4.…”

“…Patients who sustain a hip fracture have easy access to any community specialty clinic or general hospital, or can present to a tertiary hospital. In Korea, most of hip fractures are managed in private hospitals (95.8% vs 4.2% of public) and in teaching hospitals (92.8%) [37] . Incentive based funding for hip fractures does not exist nationwide in Korea, despite international evidence suggesting the benefit [12] …”