| Summary: | 碩士 === 國立中山大學 === 財務管理學系研究所 === 106 === The revenues of the hospitals are restricted by the global budget system and the evolution of medical care market, the management of the hospitals confronts the uncertainty and risk of financial responsibility. Therefore, this study intended to investigate the impact on medical care quality caused by inadeqaute health insurance payment that was resulted from the implementation of global budget system.
This study used the monthly data of the studied hospital from January 2013 to December 2016. Multiple dimensions of data analysis, including dimension of medical resources (number of attending physicians, net value of instruments and equipment), dimension of medical service (utilization rate of MRI by in-patients, average in-patient number per attending physician, average expense of single hospitalization per patient), dummy variable (Lunar New Year), and other variables, were conducted by using a multiple regression model. The correlation between health insurance revenue difference and medical quality indicators was tested by examining the impact of inadequate health insurance payment on the quality of medical care.
Except un-expected events of medication, no significant influence was caused by the health insurance revenue difference on indicators of medical care quality. However, the number of attending physicians was significantly negatively related to the un-planned re-admission within 14 days after latest discharge from hospital, average hospitalization days, and the average waiting days for hospitalization. In addition, the number of attending physicians was positively correlated with occupancy rate of beds opened. The average waiting days for hospitalization was positively correlated with the net value of instruments and equipment, on the contrary, was negatively correlated with the utilization rate of MRI by in-patients. The average expense of single hospitalization per patient did not demonstrate statistically significant correlation with any medical quality indicators. More patients cared by each attending physician led to less average hospitalization days. Significant elevation of in-hospital mortality occurred during the Lunar New Year holidays than ordinary days. Nonetheless, less hospitalization days, less un-expected events of medication, and shorter waiting days for hospitalization were disclosed during Lunar New Year holidays.
The study revealed that the number of attending physician and Lunar New Year holidays significantly affect the quality of medical care. On the contrary, the inadequate health insurance payment caused by health insurance revenue difference (average of 5.37%) was not obviously correlated with other indicators of medical care quality. Limited addition of medical budget is confined by global budget system. The audit and adjustment of medical payment should be managed with comprehensive consideration and reasonable regulations. The patient safety and quality of medical care are therefore expected to maintain well.
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