The preliminary evaluation of the Integrated Care Program for Patients with Multiple Chronic Conditions under National Health Insurance in Taiwan

• Main Authors: Yin-Ting Pan, 潘尹婷
• Other Authors: 鄭守夏
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/86886342232234023248

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 102 === Objective： 　　In recent years, patients with multiple chronic conditions (MCCs) have increasingly become a problem with high prevalence and high cost. Patients with MCC face fragmented care and lack of coordination among various health care providers because the medical system is mainly focus on acute care. In 2009, The National Health Insurance Administration (NHIA) in Taiwan implemented “The Coordinated Program for Multiple Chronic Conditions” in order to intergrate the medical services to patients with MCCs. The purpose of this study is to analyse the preliminary effect of this program on healthcare utilization, outcome and expenses. Results of this study may be of value to the NHIA. Design： 　　A before-after control group natural experimental design was used to assess the impact of the program. Patients with MCCs who joined the program were identified by the NHIA participant list as the intervention group. Patients with MCCs and who had never participated in this program were identified as the control group. According to their most frequently visiting hospitals, we selected two control groups by propensity score matching approach, one is the participating hospital control group and the other is the non-participating hospital control group. The three study groups consisted of 10,000 subjects respectively. Data for the analysis were obtained from the NHIA from 2008-2011. Difference in difference analysis was conucted to assess the program impact. Results： 1.Healthcare Utilization： (1)Using difference in difference analysis, we found that patients with MCC in the intervention group have fewer out-patient visits than subjects in the 2 control groups which reached a statistically significant level (P<.0001). (2)Results from the difference in difference analysis showed that patients in the intervention group has higher continuity of care (UPCs) than patients in the 2 control groups with P<.0001. 2.Outcome of care: Using difference in difference analysis we found no significant differences in hospitalization for ambulatory care sensitive conditions among the patients in the intervention group and the two control groups. 3.Medical expenditure: Results from the difference in difference analysis indicated that there was no difference in healthcare expenses between patients in the intervention group and participating hospital control group; but patients in the intervention group consumed lower expenses than those in the non-participating hospital control groups with β=-0.1878，P<0.0001. Conclusion： 　　Our preliminary results indicated that the Integrated Care Program reduced the numver of physician visits, increased the continuity of care and lowered the medical expenditure for participating patients. However, more comprehensive evaluation is needed to detect the long-term impact of the the integrated care program in the future.