A Preliminary Evaluation on the Integrated Management Program of National Health Insurance: The Case of Asthma in the Central Region

• Main Authors: Shih Chih-Ho, 施志和
• Other Authors: Wen Yu Pin
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/25422575758690711502

碩士 === 長庚大學 === 醫務管理學研究所 === 93 === Since July 2002 the Central Region Office of the BHNI has been carrying out a “Trial Program To Improve Expenditures For Treatment Of Asthma”, with the objective of achieving a plan under which patients would receive better treatment, and at the same time, through better management, to reduce the level of payments. Utilizing the results of this investigation the Bureau hopes to be able to reduce the recurrence of asthma attacks and the need for emergency treatment and frequency of hospital stays, thus reducing expenditures, and further facilitating proper control of this illness overall. The results will also be provided to all clinics and hospitals to help in the propagation of improved treatment and care of asthma patients, and provide a reference for proper remuneration. This investigation report uses the methods of Statistic Regression Analysis and Evidences-Based Study. The data is based on payments by the Bureau to clinics and hospital in the three counties and one city under the jurisdiction of the Central District Office through the period of January 2001 to December 2004. The data on a total of 1,832 patients who were reported by the clinics and hospitals during the period of July to December 2002 were studied. The data covered the patients’ condition collected 6 quarters before and after the trial program, and included degree of illness and use of medical resources. The investigation results showed existence of definite differences before and after the period of the trial program. Payments made to clinics and hospitals showed proportionate increases with the degree of illness. Regarding utilization of medical resources the frequency of cases requiring emergency treatment increased from an average of 2.08 of cases to an average of 2.46. Hospital stay cases increased from an average of 43.96% to 81.23%. Regarding the management of asthma cases in the four hsien and towns under the jurisdiction of the Central Region Office of the BNHI, both in the areas of degree of illness (clinical) and in the utilization of medical resources (economical), the analysis showed results far different from expectations. It is recommended that the BNHI should review and amend its standards for the management, treatment and care of asthma cases, and associate payment with good management of cases. It is further recommended that the BNHI increase health education of patients, monitor more closely the costs of patient treatment and raise the level of treatment and care.