The Impacts of Physicians' Behavior Affected by the Optimal Health Care Resources Allocation Under the Global Budget Reimbursement System

• Main Authors: Shyu, Horng-Jeng, 徐弘正
• Other Authors: Lan, Shou-Jen
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/87630851467654774476

博士 === 亞洲大學 === 健康產業管理學系健康管理組 === 102 === After the launch of Taiwan's National Health Insurance (NHI), the fee-for-service (FFS) payment system allowed hospitals to provide accessible health care. However, continually rising healthcare costs resulted in an unsustainable burden on the system. The global budget payment system (GBPS) has been implemented, which not only controlled health care costs but also motivated the hospital to enhance management efficacy. Determining how to appropriately allocate limited hospital claims resources among its physicians became an important management issue. Without proper allocation of physicians' claims resources, It could induce the unethical behaviors, such as unnecessary drug prescriptions leading to drug costs increasing and medical resources abuse. Thus, appropriate allocation of claims resources is essential to hospital revenue management. It also allows physicians to service a greater number of patients, while limiting the unnecessary waste of resources. This study analyzed the issue of claims resources allocation under the consideration of patient needs and medical services supply of physicians. This study employed the genetic algorithms (GA)and Monte Carol simulation to tackle the uncertainty of patient volumes in the optimization process. The objects of this study was to find out the impacts of physicians' behavior affected by the optimal healthcare resources allocation under the global budget reimbursement system. The study results of outpatient data revealed that physicians of over-budget group had character of well-trained background from center clinic. Their patient's profile had more severity nature with higher CMI. The physicians of below-budget group failed to meet budget in the spring season but better to meet budget in the winter season. The study results of inpatient data revealed over-budget physicians had higher CMI patients and higher service price of their prescription. The physicians' budget compliance of post allocation strategy revealed significant difference in seasons and physician's training background and patient's CMI nature by GEE statistic method. These conclusions could be suggested as a foundation of pre-implement planning of resources allocation strategy of hospital management. Hospitals could use historical data on claims' data as a basis for optimization, and utilize the existing health information system (HIS) as an self-regulation platform for managing budget by physicians.