Establishing the Fee Schedule for Surgical Procedures in Taiwan's National Health Insurance Program

• Main Authors: Yuan-Huei Huang, 黃元惠
• Other Authors: Chih-Young Hung
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/10444582319559655894

博士 === 國立交通大學 === 科技管理研究所 === 94 === Taiwan’s National Health Insurance (NHI) program was established on March, 1995. The payment system design for Taiwan’s NHI belongs to social insurance. The payment system of Taiwan’s NHI is followed that of the era of previous Government Employee/Labor Health Insurance. Many items issued from 1989 were not rationally adjusted. The inherent structures make irrational fee schedule biases and have affected the medical ecosystem. Following the implementation of NHI, the ratio of overall payments to surgical specialties was quite low due to many innate restrictions of the fee schedule in the payment system. For improving the weaknesses and establishing a rational fee schedule by precisely capture surgical experts’ opinions, this study aims to design a systemic scientific framework, which including: Delphi method, nominal group technique, analytical hierarchy process (AHP), and fuzzy multiple criteria decision-making (FMCDM) for contructing the analytic models, to achieve the following two purposes: （1） Integrate the opinions of surgical specialties about the establishment of NHI’s fee schedule for surgical procedures. （2） Construct the analytic models for surgical specilities to establishing the rational fee schedule of surgical procedures in the NHI’s program. The main processes of this study including: literatures review, survey and integrate experts’ opinions, build the AHP and FMCDM models, and empirical study of the models. Through theses processes, we can condense the surgical experts’ opinion by using Delphi method and nominal group technique. The AHP model was constructed for getting the relative weighting of each considering factors. For establishing fee schedule for surgical procedures in a NHI program, we use the FMCDM model. Finally, a new fee schedule for surgical department was completed. Nineteen meetings were held, and three were 214 surgical experts participated in this study. The results of our study strongly support that the models constructed are effective in forming a consensus among surgical specialists. The key success factors of establishing the rational fee schedule for surgical procedures depend on complete and objective data, scientific analytic methods and rational thinking process.