https://scholars.lib.ntu.edu.tw/handle/123456789/493689
標題: | Long-term effect of fee-for-service-based reimbursement cuts on processes and outcomes of care for stroke interrupted time-series study from Taiwan | 作者: | YU-CHI TUNG Chang G.-M. SHOU-HSIA CHENG |
公開日期: | 2015 | 出版社: | Lippincott Williams and Wilkins | 卷: | 8 | 期: | 1 | 起(迄)頁: | 30-37 | 來源出版物: | Circulation: Cardiovascular Quality and Outcomes | 摘要: | Background: As healthcare spending continues to increase, reimbursement cuts have become 1 type of healthcare reform to contain costs. Little is known about the long-term impact of cuts in reimbursement, especially under a global budget cap with fee-for-service (FFS) reimbursement, on processes and outcomes of care. The FFS-based reimbursement cuts have been implemented since July 2002 in Taiwan. We examined the long-term association of FFS-based reimbursement cuts with trends in processes and outcomes of care for stroke. Methods and Results: We analyzed all 411 487 patients with stroke admitted to general acute care hospitals in Taiwan during the period 1997 to 2010 through Taiwan's National Health Insurance Research Database. We used a quasi-experimental design with quarterly measures of healthcare utilization and outcomes and used segmented autoregressive integrated moving average models for the analysis. After accounting for secular trends and other confounders, the implementation of the FFS-based reimbursement cuts was associated with trend changes in computed tomography/magnetic resonance imaging scanning (0.31% per quarter; P=0.013), antiplatelet/anticoagulant use (-0.20% per quarter; P<0.001), statin use (0.18% per quarter; P=0.027), physiotherapy/occupational therapy assessment (0.25% per quarter; P<0.001), and 30-day mortality (0.06% per quarter; P<0.001). Conclusions: There are improvement trends in processes and outcomes of care over time. However, the reimbursement cuts from the FFS-based global budget cap are associated with trend changes in processes and outcomes of care for stroke. The FFS-based reimbursement cuts may have long-term positive and negative associations with stroke care. ? 2014 American Heart Association, Inc. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84927674027&doi=10.1161%2fCIRCOUTCOMES.114.001086&partnerID=40&md5=bcd7850f9efdff3b483640a322479bb8 https://scholars.lib.ntu.edu.tw/handle/123456789/493689 |
ISSN: | 1941-7713 | DOI: | 10.1161/CIRCOUTCOMES.114.001086 | SDG/關鍵字: | anticoagulant agent; antithrombocytic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; adult; aged; anticoagulant therapy; Article; cerebrovascular accident; computer assisted tomography; drug use; fee for service reimbursement; female; health care cost; health care utilization; human; major clinical study; male; mortality; nuclear magnetic resonance imaging; occupational therapy; outcome assessment; physiotherapy; priority journal; quasi experimental study; reimbursement; Taiwan; budget; cost control; economics; factual database; general hospital; health care planning; health care policy; health care quality; hospital admission; medical fee; Stroke; time; total quality management; treatment outcome; trends; utilization; Aged; Budgets; Cost Savings; Databases, Factual; Fee-for-Service Plans; Female; Health Care Reform; Health Resources; Hospitals, General; Humans; Male; Patient Admission; Process Assessment (Health Care); Quality Improvement; Quality Indicators, Health Care; Stroke; Taiwan; Time Factors; Treatment Outcome |
顯示於: | 健康政策與管理研究所 |
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