Provider behavior under global budgeting and policy responses: An observational study on eye care services in Taiwan
Journal
Inquiry (United States)
Journal Volume
52
Date Issued
2015
Author(s)
Abstract
Third-party payer systems are consistently associated with health care cost escalation. Taiwan's single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists' response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance-financed health care system. ? The Author(s) 2015.
Subjects
Game theory; Global budgeting; Provider behavior
Other Subjects
behavior; budget; eye care; game; health care system; hospital; human; market; monitoring; national health insurance; observational study; ophthalmologist; ophthalmology; regression analysis; Taiwan; budget; cost control; economics; health care cost; insurance; legislation and jurisprudence; organization and management; outpatient department; public health; statistics and numerical data; Taiwan; Ambulatory Care Facilities; Budgets; Cost Control; Health Expenditures; Humans; Insurance Claim Review; National Health Programs; Ophthalmology; Ownership; Regression Analysis; Taiwan; Universal Coverage
Publisher
Excellus Health Plan
Type
journal article