現行總額預算支付制度下地區醫院因應之策略
Date Issued
2005
Date
2005
Author(s)
池啟瑞
DOI
zh-TW
Abstract
The Global budget payment system is an effective method for controlling medical insurance expenditure from blowing out, however, the constitution of the system is designed to achieve a reasonable allocation of medical resources, enhance hospital efficiency, and ensure healthcare quality. The implementation of a global budgeting system is not intended to loose medical institutions to compete with each other in a free market, it should conduct the public seeking for proper healthcare and being cared by level. Without appropriate coordinating measures, large and small hospitals can become caught in a prisoner’s dilemma of game theory, and be left with no option but to blindly expand utilization for more income, which will instead only drive down conversion factor. Besides, the whole situation is further compounded by administrative intervention that makes less competitive area hospitals could stand in an even weaker position. In 2003, the Bureau of National Health Insurance (BNHI) ran a trial implementation of a hospital-based global budget plan in a limited number of hospitals and fully launched into all levels of hospitals in Q3 and Q4 in 2004. The statistics of the aforementioned two phases formed the base of this study with its results evaluation of the hospital-based global budget plan.
Analyses and comparisons of this study indicate that：
1. Without coordinating measures, the current global budget payment system led hospitals to enter the competition of game theory and that resulted in continuously lowering conversion factor. It has also deformed the medical ecology.
2. The Hospital-based global budget payment system functions to effectively limit medical expenditure growth. After the implementation, various quality index monitors and user satisfaction surveys have shown better results.
3. In order to ensure their financial stability and avoid a head-on confrontation with larger hospitals, it is advisable that regional hospitals, which are less competitive, seek to take part in the hospital-based global budget plan.
4. To prevent the medical industry from experiencing a full-scale crisis, the BNHI should continue to carry out the hospital-based global budget plan until a superior alternative appears.
Subjects
Global budget, game theory, hospital-based global budget, conversion factor.
Type
other
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