The Effect of Global Budget System on Integrated Delivery Services for Ventilator-Dependent Patients

• Main Authors: Huei-Ling Hung, 洪惠苓
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/86308896799069792707

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 98 === Purpose According to 2007 National Health Insurance (NHI) statistics, up to 66,080 ventilator-dependent patients (who used ventilators for consecutive 21 days and above) met hospitalization criteria, with NHI-covered admission charges amounting to as high as NT$13.7 billion. This study explores the effect of implementation of integrated delivery services (IDS) including 1 to 2 years following the IDS implementation (i.e. 1 to 2 years prior to implementation of the Global Budget System), and 1 to 2 and 3 to 4 years following the implementation of Global Budget System on the influential factors regarding medical resources such as doctor’s patient management and healthcare quality for ventilator-dependent patients, number of hospitalization days, number of days on ventilators, and medical expenses. The IDS for ventilator-dependent patients has been implemented for 10 years. During the 10 years, the Bureau of National Health Insurance (BNHI) made some revisions to the IDS, among which the most influential one is believed to be the Global Budget System (implemented on July 1, 2002). Respiratory care centers in different levels of the hierarchy were following the lump-sum payment system. The Global Budget System might create a crowding-out effect where the medical budgets for respiratory care centers in the next level of the hierarchy would be squeezed and occupied. Further observation and discussion requires to be done on whether it will undermine the healthcare quality provided to patients at these centers. Methodology This is a retroactive study where a total of 553 IDS subjects were selected from the “Details of inpatient/outpatient services,” “Details of inpatient/outpatient orders,” and the “Longitudinal Health Insurance Database” (LHID 2000), with “Inpatient expenditures by admissions” as the subject. These patients were hospitalized under NHI Order Codes 57001B (use of invasive ventilators), 57002B (use of negative pressure ventilators), or 57023B (non-invasive ventilators), and had used ventilators for consecutive 21 days and above (IDS patients defined as those falling under payment category No. 9 in the “Inpatient expenditures by admissions”). The Chinese version of SPSS for Windows 14.0 software package was used, followed by multiple logistic regression analysis and multiple linear regression analysis to explore demographic characteristics of the patients, main reasons for using ventilators, characteristics of the their diseases, severity of their diseases, whether there were other concomitant diseases or not, and whether doctor''s patient management, healthcare quality, and medical resources available for the IDS patients were affected as a result of the Global Budget System or not, and forecast related factors on the medical resources available. Study Results Generally speaking, in terms of patients’ characteristics, main reasons for using ventilators, characteristics of their diseases, severity of their diseases, and characteristics of hospitals, the implementation of Global Budget System did not affect the insured patients’ accessibility to medical treatment during the three periods: 1 to 2 years following implementation of the IDS program (1 to 2 years prior to implementation of the Global Budget System), 1 to 2 years following implementation of the Global Budget System, and 3 to 4 years following implementation of the Global Budget System and the implementation of the Global Budget System did not affect doctors’ disease management and medical resources available for the patients. The hospitals continued to emphasize healthcare quality provided to patients to ensure optimal results. The healthcare professionals are admirable for they managed to maintain certain medical care quality under the strict cost control imposed by the Global Budget System. In light of this fact, many scholars suggested that clinical care guide should be followed and various studies be referenced to establish quality monitoring indicators as soon as possible. They also advised to consolidate incentive programs to ensure better healthcare quality. Conclusions and Suggestions The DRG system took effect in the beginning of this year. However, there has not been practical experience in payment by the course of disease and time slot of care in Taiwan. By analyzing and studying related factors in the IDS program, e.g. trends and responses such as medical expense, cost of care, quality index, Global Budget System package measures, and effect from an autonomous management system, related benefits and shortcomings can be verified to come up with the most cost-effective payment system for ventilator-dependent patients and consolidate quality of medical services available for the patients. Therefore, how to upgrade service efficiency and high quality care under effective and reasonable medical care management is crucial to the optimization of health care and use of medical resources in the future.