The Impacts of Outpatient Dialysis Global Budgets on Nephrologist Behavior
Date Issued
2008
Date
2008
Author(s)
Wu, Chia-Ying
Abstract
Background:National Health Insurance implemented the global budget for primary care since July 2001. With expectations of the pre-set amount of budget caps and the mechanism of peer review to promote the reasonable price of medical services provided, and effective control medical costs. It is widely accepted that payment will affect how physicians practice medicine, thereby affecting consumption of medical resources. Dialysis care is a high-volume, high-priced medical service, and the number of patient requiring dialysis increase rapidly. Besides, the budget allocation framework of the provision was an independent budget.bjective:The purpose of this study is to investigate the impacts of outpatient dialysis global budgets on nephrologist behavior.ethods:This research is a natural experiment. The study subjects are licensed nephrologists who had practiced dialysis services from July 1999 to June 2002. Using National Health Insurance Research database for research, the nephrologists practicing in clinics are the experimental group, and the nephrologists in district hospitals are the control group. Adopting the differences-in-differences method and generalized estimation equation approach, the impacts of outpatient dialysis global budgets on nephrologist behavior were analyzed.indings:. Compared to the nephrologists of district hospitals, prior to the implementation of outpatient dialysis global budgets, the nephrologists of clinics may have anticipations effect and therefore increase outpatient dialysis services in advance. Medical expenses also increase significantly. . Compared to the nephrologists of district hospitals, after the implementation of outpatient dialysis global budgets, the global budgets of dialysis services have positively affected the services provided by nephrologists. he results suggested that the health administration should develop management strategies in advance in order to reduce expectation effects and adverse policy effects before a policy is implemented.
Subjects
global budget
dialysis services
physician behavior
Type
thesis
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