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Enhancing quality of healthcare under the national health insurance system: Identification of factors reducing quality of care in Taiwan

机译:在国民健康保险制度下提高医疗质量:确定降低台湾医疗质量的因素

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  This study examines whether the quality of community health in Taiwan has improved after the establishment of the National Health Insurance (NHI); to identify what the related factors are that affect the quality, and to find the possible ways to improve key drivers of healthcare quality. Data were collected from the National Health Insurance Annual Statistics Information Database and the Taipei Health Information Indices Database in the form of unbalanced panel of 153 hospital-years from 1989 to 2002 in 13 Taipei public hospitals within different districts. In addition, panel data analysis with fixed effects model was conducted to identify what factors affected the quality of healthcare before and after the advent of the NHI. After the NHI, quality of care improved insignificantly. The elderly, market competition, new technology, average length of stay (LOS), scale, physician density and nurse to patient ratio were all major factors affecting quality. Moreover, lower doctor density, longer LOS and increased in the number of elderly led to deterioration in the quality of care. The government could improve quality of elder-care by encouraging the re-building of three-generation family values. Policymakers should also permit public hospitals to institute the incentive programs for their professional staffs. In addition, quality could be improved by having hospital managers who enhance efficiency by decreasing the LOS.  
机译:这项研究探讨了在建立国民健康保险(NHI)之后,台湾社区健康的质量是否有所提高;确定影响质量的相关因素是什么,并找到改善医疗质量关键驱动因素的可能方法。数据来自全国健康保险年度统计信息数据库和台北市健康信息指数数据库,以不平衡的方式从1989年至2002年的153个医院年的面板中收集了不同地区的13家台北公立医院的数据。此外,进行了具有固定效应模型的面板数据分析,以确定在NHI出现之前和之后哪些因素影响了医疗质量。在NHI之后,护理质量的改善不明显。老年人,市场竞争,新技术,平均住院时间(LOS),规模,医师密度和护士与患者的比例都是影响质量的主要因素。此外,较低的医生密度,较长的LOS和老年人的数量增加导致护理质量下降。政府可以通过鼓励三代家庭价值观的重建来提高老年人的护理质量。政策制定者还应允许公立医院为其专业人员制定激励计划。此外,可以通过让医院管理人员通过降低LOS提高效率来提高质量。

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