The Impacts of National Health Insurance Program of 「Hospital Excellency Project」on Hospital Behavior - A Case Study of a Medical Center in Taiwan
Date Issued
2005
Date
2005
Author(s)
Lo, Tzu-Ping
DOI
zh-TW
Abstract
The Bureau of National Health Insurance officially put into enforcement the “Hospital Excellency Project Payment Principles, 2004”(“Hospital Excellency Project”) on July 1, 2004. Under the Plan, all hospitals should file applications to the Bureau of National Health Insurance with their respective Hospital Excellency Projects in writing at the fixed ratio between outpatient and inpatient services at (45:55). It is hoped that the medical treatment costs can be put under control from further rises year-by-year by means of total quantity control (total mass control) by hospitals themselves respectively.
The present study aims at the outpatients who called the case hospitals as the samples to probe into the variation curves of the numbers of patients, medical treatment costs and such medical behaviors before, during involvement of the factors in the “Hospital Excellency Project” enforcement, and after annulment of such enforcement. Through the findings so obtained, the study is to assess the influence of the Hospital Excellency Project upon hospitals and clinics upon their operations.
The major findings yielded in the present study are enumerated below:
I. In the aspects of number of outpatients, medical treatment costs, examination costs and pharmaceutical costs:
During enforcement of such Plan, number of outpatients, medical treatment costs, examination costs and pharmaceutical costs showed significant signs of decline. After the plan was annulled, the medical treatment costs, examination costs and pharmaceutical costs were found to have significant increase while the number of outpatients did not have a significant increase.
II. Variation of the number of outpatients attended by doctors/physicians:
The involvement of the Plan led to a drop in the number of outpatients attended by doctors/physicians. After the Plan was annulled, the number of outpatients attended by doctors/physicians still showed signs of decline.
III. Variation in the ratio taken by outpatient services:
The outpatient services accounted for 42.94% to the total every month prior to enforcement of the Plan. The ratio down to 40.39% every month during enforcement of the Plan and a slightly up to 42.17% after the Plan was terminated.
IV. Ratio of pharmaceutical expenses:
The ratio of pharmaceutical expenses decreased by approximately 3% every month during enforcement and rose insignificantly within less than 1% after the enforcement came to a halt.
V. The influence upon outpatient services of various clinical departments:
During enforcement of the Plan, the numbers of outpatients visiting various departments came down. The outpatient service expenses, including examination expenses and pharmaceutical expenses did not come down. After the Plan was suspended from enforcement, outpatient service expenses, including examination expenses and pharmaceutical expenses did not come up significantly.
VI. The influence upon the emergency cases:
The emergency treatment expenses incurred every week did not show a significant increase after the Plan was suspended from enforcement compared with the expenses incurred during enforcement. The per patient treatment costs, nevertheless, showed a significant rise.
Summing up the key findings quoted above, the present study would offer the following proposals:
I. Proposals posed toward the medical treatment policymakers:
Upon policymaking process, it is advisable to come to the politic and managerial targets which would accurately aim at patients’ demand and hospital characteristics. The policies, once made, should be enforced consistently as far as possible, with as little change as possible. In turn, the hospitals will get a firm rule to comply with and thus upgrade the quality of medical treatment.
II. Proposals posed toward hospital management:
Aiming at the respective hospital missions and visions, the hospitals should try their utmost efforts to offer the best possible quality of medical treatment. Meanwhile, they should try to have patients of varied demands receiving medical care as appropriate.
III. Proposals posed toward subsequent researchers:
Change in other medical treatment behaviors of hospitals, change in the behaviors of medical care toward outpatients, the characteristics of doctors/physicians toward the involvement of the policies and such issues are advisable issues for subsequent study in the future.
Subjects
全民健康保險
總額預算
總額支付制度
National Health Insurance
Global Budget
global budget system
Hospital Excellency Project
Type
thesis