| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學研究所碩士在職專班 === 93 === Aim
Since the BNHI started global budget payment system in year 2002, each hospital competed until the “point value” went down. The aim of promoting hospital excellent program was to hope that hospital would individualize to decrease the risk of hospital reengineering, ensure patient health right and ensure medical quality. This study used the concept of game theory to see the outcome of join in or not join in term of changes in their net income, patient screening and medical quality.
Method
This study design was experimental method, one medical center and two regional hospitals that choose to “join in” and one medical center and two regional hospital of the same size that choose “do not join in” were compared. Using the data from BNHI and SPSS, 10 version to analysis payment and relative indicators between the two period that is September to December 2003 and September to December 2004
Result
After the intervention of excellent program 1) those join in, both medical center and regional hospitals, got higher payment and lower rate of rejected payment. 2) Those join in their CMI value was able to reach within range targeted. 3) In term of rate of achieving the targeted quality, OPD occupied rate was lower for medical center that join in; average length of stay in medical center also achieved targeted value indicator value; rate of OPD antibiotic usage for both medical center and regional hospital that join in all achieve targeted value. Drug expenses increase rate for both medical center and regional hospital that join in all achieve targeted value. In conclusion, those join in the excellent program got higher net payment and less rejected payment rate and still achieved the indicator of good medical quality.
Discussion and suggestions
As a whole, those join in achieved better hospital income, patient screening and good quality indicator. It showed that hospital excellent program can achieve it goal, ensure patient medical right, improved medical quality, respect of medical expert autonomy and decrease risk of hospital management. Just that using the result of only one sector is only a primary effect. At the early stage of re-engineering, hospital adjustment is not easy and may occur certain complication that need time and experience accumulation and to discover more problem to be solve. So we suggest to continued the hospital excellent program at least a year, to accumulated more experience and more reviews before this program can be use as the basic plan for future to carry out an expended similar program.
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