A Study of Relationships between the National Health Insurance System and Hospital Management － a Multi-winner Strategy Based on Patient
Date Issued
2006
Date
2006
Author(s)
Huang, Shiuh-Ming
DOI
zh-TW
Abstract
Since the 21st century, the Medical Care Expenditure (MCE) from National Health Insurance (NHI) has increased very quickly. Until 2004, the short–term borrowing was nearly NT 90 billion. The current assets to debt ratio increased from 1.82 in 2000 to 1.99 in 2004. This ratio shows that we have violated the principle of turnover rate. The cost of medical care increased 15% between 2000 and 2004, but the ratio of MCE to premiums decreased from 3.02 in 2000 to 2.98 in 2004. During these five years, the out-of-pocket MCE for each family increased 26%, whereas the out-of-pocket MCE for each family increased only 10% from 1995 to 1999. This phenomenon shows that the inequity of MCE has increased.
One reason for the inequity of MCE is the operational performance of hospitals. In 2004, the hospital’s total income from the NHI increased 15%, but the total surplus decreased 50%. Based on this data, the hospital strategy is to create a new service, which is the out-of-pocket MCE, and decrease the cost. The results of the hospital strategy are that inequity of MCE has increased, and medical care quality has suffered. At the same time, the Bureau of NHI’s (BNHI) strategies do not respect the medical professional, hence lowering medical care quality and violating the equity of MCE.
How does one maintain a constant surplus for hospitals and keep quality of patient care with limited resources? One of the solutions is to reforming the payment system of the NHI is capitation—everyone pays the same fee.
The central thinking process of this research is to make the patients, who really need medical care, get the right medical care. The goal is to maintain not only a constant surplus for the hospitals but also financial solvency of the NHI, while valuing the medical demands of patients.
This research studies the medical utilization history of patients, and then it allies all the intersections of hospitals that patients have visited before into a coalition-health-management-hospital (CHMH).
The BNHI analyzes the core-competition-ability of each hospital and the total number of patients for each hospital. Utilizeding the above data which containeds the income of the hospital and the MCE of each patient, the BNHI can set a modified capitation payment system.Under this modified system, hospitals have the responsibility offer each patient’s health. Patients can choose any CHMHs which patients they like, and patients can switch their hospital from A to B. When a patient decides to stay at B hospital, hospital A has to pay the MCE to hospital B, but hospital A has the right to audit the quality of hospital B..
The responsibility of different CHMHs and the responsibility between the patient and his CHMH will be balanced. The CHMH will focus on qualities and services: it will perform the best professional services, substitute managed health for medical care, induce patients to buy health, rather than treatment. If so, all the hospitals will get stable incomes and constant surpluses. Also, unnecessary competition will be diminished, and the growth of the MCE will be under control.
This research reveals that there are correlations between disease patterns and the number of hospitals that a patient visits each year. Based on the above phenomenon, the modified capitation payment system is available. This research suggests that we have to simulate more modified capitation models.
Subjects
短期借款
流動比率
論人計酬
健康管理聯盟
short–term borrowing
assets to debt ratio
capitation
coalition-health-management-hospital
Type
other
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