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The impacts of global budgeting payment scheme on inpatient care performance in Taiwan.

机译：全球预算支付计划对台湾住院服务绩效的影响。

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摘要

Taiwan's National Health Insurance implemented hospital-level global budgeting since July, 2002. There are some concerns that global budgeting will impact the inpatient care performance of hospital differently by hospital levels, since the capability of different levels of hospitals to control health care spending varies. Literature suggests that hospital will aggressively compete with one another to provide more services in order to maintain their share of income in a fixed budget region.; To address this issue, this study addressed three research questions to explore the impacts of global budgeting on inpatient care performance, for controlling hospital characteristics, competition, and environment factors. The study used two diagnoses with distinct clinical implications, pneumonia as a condition allowing substantial provider discretion in admission and discharge decision-making and hip fracture as a condition that is less amenable to clinical discretion. This study examines differences in care and services indicators for these two conditions.; Descriptive and multiple regression analyses were performed to compare care and services provided for these conditions in two six-month periods, before and after global budgeting. Data from the National Health Insurance database and hospital database were used, covering all hospitals operational in both study periods, excluding psychiatric hospitals.; There are three important study findings. First, the average length of stay and average fee per discharge increased after implementing global budget scheme. Second, different types of hospitals responded to global budgeting differently. Third, it shows that provider can manipulate the services when the situation permits discretion to make choices. These research findings suggest that policymakers need to carefully monitor the impact of global budgeting on disadvantaged hospitals and evaluate their important role the integrity of health care system. In addition, a sound system needs to be established in order to monitor and regulated health service utilization to prevent wastage of health care resources caused by wasteful competition under global budgeting.
机译：台湾的国民健康保险从2002年7月开始实施医院级别的全球预算。由于各级医院控制医疗保健支出的能力各不相同，因此全球预算会对医院的住院护理绩效产生不同的影响。文献表明，医院将相互竞争以提供更多服务，以保持其在固定预算地区的收入份额。为了解决这个问题，本研究解决了三个研究问题，以探索全球预算对住院护理绩效的影响，以控制医院的特征，竞争和环境因素。这项研究使用了两种具有不同临床意义的诊断：肺炎是允许提供者在入院和出院决策时做出重大决定的条件，而髋部骨折是在临床上难以做出的条件。这项研究检查了这两种情况在护理和服务指标上的差异。在全球预算之前和之后的两个六个月中，进行了描述性和多元回归分析，以比较针对这些情况提供的护理和服务。使用了来自国家健康保险数据库和医院数据库的数据，涵盖了在两个研究期间运营的所有医院，但不包括精神病医院。有三个重要的研究发现。首先，实施全球预算计划后，平均住院时间和每次出院平均费用有所增加。其次，不同类型的医院对全球预算的反应也不同。第三，它表明，当情况允许酌情做出选择时，提供商可以操纵服务。这些研究结果表明，决策者需要仔细监控全球预算对处境不利的医院的影响，并评估其在卫生保健系统完整性中的重要作用。此外，需要建立健全的系统，以监测和规范卫生服务的利用，以防止在全球预算范围内浪费性竞争造成卫生资源的浪费。

著录项

  • 作者

    Chen, Fen Ju.;

  • 作者单位

    University of South Carolina.;

  • 授予单位 University of South Carolina.;
  • 学科 Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2005
  • 页码 133 p.
  • 总页数 133
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;
  • 关键词

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