Establishing of The Forecasting Model of Laboratory Test under NHI--A Case Study on Utilization Rate in An Academic Medical Center

• Main Authors: huang hsiang ching, 黃鄉卿
• Other Authors: 馬作鏹
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/95757763347252638486

碩士 === 中國醫藥學院 === 醫務管理研究所 === 90 === 　In Taiwan, since the National Health Insurance (NHI) program was first implemented in 1995, we have seen an increase in expenditure from under NT $ 137 billion to over NT $ 230 billion in 2000. As a result, several cost containment mechanisms including cost-sharing, financial burden on those frequent visitors in the outpatient clinic, NHI has implemented rational outpatient volume and a hospital self-managerial strategy to solve the deficit problem. 　Those mechanisms have serious impacts on the continuous operating of hospitals. In order to maintain competence with other healthcare providers, hospital’s manager should have a long-term planning for manpower and facilities within the hospital. 　Utilization of clinical laboratory services has been an important sector, around 10%, of the overall hospital revenue. It is necessary that hospital’s manager understand the trend of laboratory service utilization and establish an efficient strategic planning for manpower and facilities in the department of clinical laboratory services. 　The purpose of this study was to build-up a forecasting model for laboratory service utilization. The independent variables are total outpatient volume, % outpatients utilizing laboratory services, the number of physicians served in the outpatient clinic, and a few other intervening factors. The method of Box and Jenkins’s time series was used to construct three prediction models for comparisons. The dependent variable is the rate of laboratory utilization. 1.ARIMA Model AR(1): Our statistical data indicated that there was an association among the observed values in terms of utilization rates, but a close correlation was only present in any two consecutive periods. 2.Transfer Function Model: If only utilization rates over total outpatient volume were considered, it was estimated that there is an increase of 0.8 unit of laboratory service utilization in every 1000 cases. 3.Intervention Model: If all other intervening factors were considered, only cost-sharing factor under a three-level outpatient service system (i.e., $150 for medical centers, $100 for regional hospitals and $50 for all other Preliminary clinics as the outpatient service co-payment under current NHI system) has an impact on utilization rates. This has caused an increase of up to 2.2%. 　Base on the rules of MAPE, RMSE, and MAD, we concluded that although all of the three models are good enough to serve as predicated model, AR(1) is chosen as the best one.