Did Reduction on Hospital Outpatient Global Budget Influence the Patient-Shifting

• Main Authors: Chien-Yi Liao, 廖千儀
• Other Authors: Yue-Chune Lee
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/62165967236441562730

碩士 === 國立陽明大學 === 衛生福利研究所 === 95 === Background In 2004, the ratio of hospital outpatient and inpatient global budget (OPD/IP ratio) of National Health Insurance (NHI) was changed from 50:50 in 2003 to 45:55 that end to 9.09% cut. On hospital outpatient global budget, hospitals might change their behaviors in response to this policy changes. Objectives The purpose of the study was to explore how reduction on hospital outpatient global budget might influence the patient-shifting. Methods This study was a natural experiment. We applied pretest-posttest design to compare the changes on the admission rates, before and after the reduction on hospital outpatient global budget, based on the analysis of National Health Insurance claim data (2003-2004). In the study, all services were divided into “emergency”, “operation”, “specific diagnosis and treatment” and “specific material.” Besides we classified non-emergency services into high price and low price services, to compare the changes in admission rates related to the price of the services. There were 390 hospitals provided emergency services, 377 hospitals provided operation services, 471 hospitals provided specific diagnosis and treatment services and 299 hospitals provided specific material services. To assess the impacts of the policy changes, we applied generalized estimation equation (GEE) model by SAS. Results 1.The impact of the reduction on hospital outpatient global budget in 2004 on patient-shifting varied among different types of services. Yet only the admission rates following emergency services were significantly increased. The admission rates following specific diagnosis and treatment were significantly reduced. 2.Regardless of types of services, admission rates associated with high price services were reduced more than that of low price services. 3.The impact of OPD/IP ratio on patient-shifting of different types of services varied among hospitals different at region, type and ownership.