An Evaluation of Strategies and Effect of Case Payment System on Accredited Teaching Hospitals in Taiwan

• Main Authors: HUNG, CHIA-LING, 洪嘉玲
• Other Authors: CHUNG, KUO-PIAU
• Format: Others
• Language: zh-TW
• Published: 2001
• Online Access: http://ndltd.ncl.edu.tw/handle/66224848673933839649

碩士 === 國立台北護理學院 === 醫護管理研究所 === 89 === The purpose of this cross-sectional study was to explore the relationship between the strategies utilized and the outcomes achieved by accredited teaching hospitals in dealing with the case payment system introduced by Bureau of National Health Insurance (NHI) in Taiwan. A structured questionnaire, developed by this researcher with its content validity established by 9 experts, was sent to a targeted population of 129 teaching hospitals. The response rate was 62.2%, i.e., 79 hospitals completed and returned the survey. The data thus collected were analyzed using descriptive, t-test, Chi-square/Fisher exact, one way ANOVA and logistic regression analysis. There were three important findings from this study. (1) Hospitals that utilized more of the inpatient transferring factor strategies by shifting more services from inpatient areas to outpatient departments, saw their subjective operating cost, subjective operating revenue, subjective profit before tax and subjective average length of stay reduced. (2) Hospitals that implemented more of the strategies of continuing and integrative service factor, e.g. clinical pathway and patient satisfaction survey, found their subjective operating cost, subjective average length of stay, subjective readmission rate within fourteen days, all declined. And, their net mortality growth rates also decreased when comparing before(in 1997) and after(in 2000) the introduction of case payment system, but perceived patient satisfaction rates were increased. (3) Hospitals that adopted more of the organizational development factor strategies, such as developing popular special programs and establishing a better way of communicating with Bureau of NHI, experienced increased subjective profit before tax, subjective average occupancy rate. And, inpatient-day growth rates were also increased when comparing before and after the introduction of the case payment system. Based on the results of the study, three suggestions were made: (1) If the case payment system is to be expanded, Bureau of NHI needs to develop a mechanism to ensure that medical costs are monitored and controlled. (2) Hospitals need a solid organizational development plan to enhance the effective and efficiency of their organizations. (3) Future researchers can focus on longitudinal studies to examine the long-term effects of governmental health policies, such as the case payment system, on hospitals. We also hope that objective measures can be established and data can be obtained nationwide, on a regular basis to facilitate better understanding of organizational effectiveness and market competitiveness among health care organizations.