Reappraisal of Neonatal Health Care in Taiwan: Toward a Value-Based System Approach
Date Issued
2010
Date
2010
Author(s)
Hsieh, Wu-Shiun
Abstract
It is well known that United States is currently undergoing an important debate on the issues of health care reform. There is much rhetoric about the dangers of reform, the likelihood of rising costs, the negative role of government versus the private health provider in administering health care, the merits and weaknesses of a single-payer system, the value of free markets versus regulated markets, etc. Michael Porter and Elizabeth Teisberg suggested that the wrong kinds of competition have made a mess of the American health care system. They urged that redefining competition in health care be mandatory and shifting the delivery of services to the value based system with more efficiency, better outcomes, and lower prices can solve many of the health care problems in United States.
Unlike the U.S. health insurance system, Taiwan''s health insurance system, the National Health Insurance, which had been launched since 1995, had actually improved the financial burdens of the insured family in general, for the high risk newborn infants in particular. However, despite the improved burdens, this national-wide covered health insurance system has received numerous complaints and critics from various stakeholders, including the health providers, the employers, and the insured patients. Especially, we are facing rapidly rising health care costs. The true equity and the efficiency of the current health care system are therefore an important issue for further research which motivates the present research.
Within the context of newborn infants, compared with the western developed countries, the neonatal mortality rate and the infant mortality rates in Taiwan remain high. Despite the nationwide health insurance, there exist regional discrepancy of neonatal mortality and infant mortality which deserves further attention and reappraisal. The present research attempts to make an initial effort to tackle this issue by applying Porter and Teisberg''s value-based system approach to our existing neonatal health care practices and reimbursement policy.
Our research first revealed that the neonatal health care in Taiwan is generally running smooth. The current supply chain of the neonatal care had demonstrated that we had a good clinical performance including the continued perinatal and neonatal health care. We also showed that the manpower of specialists for caring the high risk newborn infants may be sufficient in the urban area. However, there remains regional discrepancy of the manpower in rural area especially in eastern Taiwan.
To evaluate the value of newborn infant care, we used the Longitudinal Health Insurance Database 2005 (LHID2005) retrieved from the National Health Insurance Database for further analyses. Like the western developed countries, the preterm birth and low birth weight infants in Taiwan had imposed an immense burden on the health care costs. We found that there is no significant difference in neonates’ health care expenditures across five different geographic areas during the neonatal and infantile period. We then performed a novel approach by measuring a negative value calculated as the mortality rate (‰) in per thousand divided by the total health care cost in per hundred thousand NT dollars spent. We found that the negative value was most prominent in the eastern area of Taiwan where the medical accessibility is comparatively difficult than other areas. Although the current data set may contain insufficient information which may limit research inference, this result would indicate the potential of applying value-based approach to directing sufficient medical resources to rural areas so that overall neonatal health care quality can be improved. Implications of research results and suggestions to the existing health care policy are also discussed.
Subjects
health insurance
neonate
preterm
value-based approach
SDGs
Type
thesis
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