The effects of global budget on the medical expenses of schizophrenia patients

• Main Authors: Shih-Pei Shen, 沈詩佩
• Other Authors: Ying-Chun Li
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/42004404663653160805

碩士 === 國立中山大學 === 醫務管理研究所 === 99 === Purpose: The Bureau of National Health Insurance (BNHI) use the Global Budget (GB) System to control the medical expense growing up, and it was put into practice in each hospital in July 2002. This research explores the medical expense before and after the GB System was put into practice. Method: Using the data of BNHI, we explore the average daily cost of admission data of schizophrenia (ICD-9 CM code 295) in acute ward. The total cost were separated into several detail subjects (drug amount, psychiatric treatment amount, test amount, self payment amount, and other) to be analyzed. Data of 1999 and 2000 were selected as “before GB period”, and 2003 and 2004 were selected as “post GB period”. We also collect following variables to adjust the effect of GB. Patient’s data: age, gender, comorbidity, insurance count, urbanization. Hospital data: hospital levels, hospital power, geographic location, owner, teaching hospital. Doctor data: age, gender. The 14-day and 30-day re-admission rate. Results: The growth of total medical expense is 40% after the implement of GB, which is lower than the estimated 60%. In the psychiatry, the total cost or subgroups of the total cost were increased. The average daily drug amount were 150.42 NTD before the GB，and192.53 NTD post GB; the psychiatric treatment average daily amount was 551.24 NTD before the GB, and 737.94 NTD post GB; the average daily test amount was 75.54 NTD before the GB, and 90.60 NTD post GB; the average other amount was 970.03 NTD before the GB, and 1317.06 NTD post GB; the average daily total medicine amount was 1773.18 NTD before the GB, and 2371.92 NTD post GB. After adjusting the patient, doctor, hospital, and studying year, the before/after GB is still an independent factor to predict higher cost in every amount. Nevertheless, the growth of the average daily total medicine amount is minimized to 14.83% which is much lower than the growth of 40% of the total medical expense after the adjustment of the individual items. After adjusting patient’s, hospital’s and doctor’s factors, the 14-day and 30-day re-admission rates are lower than “before GB period”. Conclusion: The short-term re-admission rate, one of the medical quality indicators, declined after the implement of GB and the growth of total cost at least was suppressed to the set goal. Various adjustments of medical behaviors are believed to be made to get the best cost-benefit.