The Effect of NHI IC Card on the Utilization of CT and MRI－Using Data from Medical Centers and Regional Hospitals in Taiwan As Example

• Main Authors: Chiao-Yi Lu, 陸教義
• Other Authors: Yong-Yuan Chang
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/47178249721281913759

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 95 === OBJECTIVE: 　　The continual increase in medical expenses year by year is a common problem that is facing many countries, and the utilization of hi-tech medical products is considered to be one of the major causes . This study is to discuss whether the introduction of IC card into National Health Insurance in 2003 and the implementation of the registration and upload of important physician orders such as orders on Computerized Tomography(CT) and Magnetic Resonance Imaging(MRI) after January 1, 2004 has decreased the repetitive utilization of CT and MRI. The study purpose is to lower the medical expenses since medical clinics can learn from medical records in the National Health Insurance IC cards the execution information on important physician orders of patients when they consult a doctor. RESEARCH PURPOSE: (1) Compare the differences in utilization rates of CT and MRI in out-patient clinics before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (2) Compare the differences in utilization rates of CT and MRI in in-patient departments before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (3) Compare the differences in medical expenditures on CT and MRI in out-patient clinics before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (4) Compare the differences in medical expenditures on CT and MRI in in-patient departments before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (5) Analyze factors relating to the changes in utilization rates and medical expenditures on CT and MRI before and after the implementation of the registration and upload of important physician orders into NHI IC cards. METHODS: This study takes insurants of National Health Insurance in Taiwan who had been out-patients or in-patients of medical centers or regional hospitals during 2004 and 2005 as research objects. In addition, data that match these research objects in the corresponding years were sampled(1-in-500 for out-patients; 1-in-20 for in-patients) from the National Health Insurance Information Database of National Health Research Institute as research samples to carry out comparisons and statistical analysis on the utilization rates of and the medical expenses on CT and MRI for out-patients and in-patients before and after the implementation of the registration and upload of important physician orders into NHI IC cards. RESULTS： The research indicates that, after the implementation of the registration and upload of important physician orders into NHI IC cards, the medical utilization rates of CT and MRI in in-patients in medical centers (the ratio of the number of CT or MRI examinations to the number of in-patient visits at the same medical level in each corresponding year) decreased from 16.8% to 16.2%; the medical utilization rates of CT and MRI in in-patients in regional hospitals decreased from 14.2% to 13.4%. Both achieved statistical significance. While on the aspect of medical expenses, the expenditure rates of CT and MRI to the total medical expenses in medical centers (the ratio of the expenses on CT and MRI examinations to the total in-patient medical expenses at the same medical level in each corresponding year) decreased from 2.34% to 2.15%; the expenditure rates of CT and MRI to the total medical expenses in regional hospitals decreased from 2.44% to 2.28%. Both also achieve statistical significance. RESULTS AND SUGGESTIONS: 　　Despite that significant decreases in the utilization of and the expenses on CT and MRI only appeared in in-patients in relating medical centers and regional hospitals and there was no significant decrease of that in out-patients, however, from the Growth Trend of Utilization and Expenditure of CT and MRI from 1999 to 2005 we can discern signs of slowing-down. These suggest that the implementation of the registration and upload of important physician orders might be an important policy to slow down the growth of medical expenses.