An Analysis of Medical Utilization and Expenditure before and after the Intervention of Integrated Delivery System in Matsu
Date Issued
2004
Date
2004
Author(s)
Shieh, Chun-Fu
DOI
zh-TW
Abstract
Lien-Chian County was commonly called Matsu Island. Integrated Delivery System (IDS) of Matsu was entrusted to Lien-Chian County Hospital by the Bureau of National Health Insurance on March 1st 2000. Initially we coordinated with Taipei Medical Association to sent medical doctors in support of specialist therapy in Matsu. Because the support was instable, we changed to seek support from Taipei Municipal Hospitals on June 1st 2000. The Purpose of this research was to discuss the effect of IDS on the utilization and expenditure of out- patient, admission and preventive services in Matsu, and to understand the ratio of going to a doctor inside and outside the county.
This research was a natural experiment, we observed 4 years of IDS program. In order to excluding the effect of external environment, we used the method of experimental year and control year. Experimental year was defined as the year of carrying out stable IDS, and control year was defined as the year of carrying out unstable IDS. This research used secondary data from the database of the Bureau of National Health Insurance, to analyze the declaration data of the population of family registration in Lien-Chian County from 1999 to 2002. We used difference in difference and Chi-square test to examine the effect of the IDS program..
The major findings of this research are listed as follow:
1. The overall utilization of out-patient-department (OPD) revealed the annual average OPD utilization before the intervention of IDS was 9.5(1999), 10.1(2000), and 10.7(2001), 10.7(2002) after the IDS. There was an increasing tendency.
2. The medical expenditure of OPD of each person also shows an increasing tendency, which was NT$ 6,557.4 before IDS intervention and 7,055.0 after, the growth rate was 7.6%. The expenditure inside the county increased before IDS intervention from NT$ 3007.4 to NT$ 3345.8 after, the growth rate was 11.3%. The growth rate of average utilization per person was –1.5%. It is possible because there are no high price of medical procedure and medicines in spite of the increase of OPD volume.
3. After the intervention of IDS, the annual admission utilization increased from 670 to 766, the growth rate was 14.3%. Admission utilization ratio increased from 18.4% (2000) to 23.2% (2001) inside the county. Although the ratio was increased, but it also suggests that the residents did not have confidence toward the medical quality inside the county.
4. Among the preventive services, the volume of the adult health examination was unstable, and it will change the result of the statistics and analysis. Because the volume of the healthy baby clinic was not related directly to the volume of adult health examination, so it was a good indicator. In the analysis of volume of healthy baby clinic, the volume increased from 67 persons (2000) to 190 persons (2001), the growth ratio was 183.6%, and the ratio of the volume of inside county and outside county was increased.
5.The utilization ratio of OPD and admission outside the county decreased after IDS intervention. It revealed that if we increased medical resource supply, the ratio of long way trip due to going to a doctor from Matsu to Taiwan would be decreased.
6. The service volume of the existing medical organization in the county increased after intervention of IDS. Because of the volume of medical service was stable in 2002, except for adding new items of health services, it will not be possible to have positive growth rate.
7. After intervention of IDS, although the volume of avoidable admission of the whole county changed from 68 persons to 65 persons, and the decreased rate was –4.4%, but there was no decreasing tendency.
Finally, this research discovered that there were increased tendency of the overall volume of OPD utilization, admission and preventive service after IDS intervention. Overall OPD expenditure of each person had growth tendency, each person’s OPD expenditure in the county had negative growth. The overall OPD or admission utilization outside the county decreased after IDS intervention; but avoidable admission had no decrease for a long time period. The OPD volume of existing medical organizations had positive growth after IDS intervention.
This research suggest that we should continue to strengthen the human resources and facility of existing medical organization in the county, well trained public financed doctors are the first choice when recruiting new staff; the transportation among Matsu islands should be improved; the number of internal medicine and surgical doctors should be increase to strengthen the support; and the consistency of support of IDS program must be taken into consideration.
Subjects
差異中之差異
就醫公平性
醫療利用
醫療費用
整合性醫療照護
difference in difference analysis
medical care expenditure
health care utilization
Integrated Delivery System (IDS)
health care equity
Type
thesis
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