The Effect and Trends of Hospital Global Budget Payment System on Inpatient Medical Utilization for Elders
| Autor: | Chia-Wen Yu, 尤嘉文 |
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| Rok vydání: | 2011 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 99 Introduction : Taiwan is facing an aging population, healthcare expenditures of elders is increasing rapidly, especially in oldest old (over 85 years old). The hospital global budget payment system was introduced July 1, 2002, taking the change of population structure rate into consideration. It’s necessary to know the changes of inpatient medical utilization for elders after hospital global budget programs. The aims of this study were to exam the change of inpatient medical utilization and expense for elderly patients 2001-2009, evaluate the effect of hospital global budget on inpatient medical utilization and expense for elderly patients, and to analyze the trends of inpatient medical utilization and expense for elderly patients in different hospital. Methods : A retrospective study is adopted.Secondary data analysis of hospital claim data files that were obtained from the Bureau of NHI. The subjects of this study were all inpatients in 2001-2009. The multiple regression was used to evaluate the effect of hospital global budget on inpatient medical utilization and expense for elderly patients. Result : A total of 16,319,021 inpatients in 2001-2009 were enrolled. The hospitalization rates of oldest old were still increased after hospital global budget; it was 310 per 1,000 populations in 2009. The length of stay, length of ICU, medical expense, room costs, therapy costs, materials costs, and diagnosis costs of inpatients over 85 years old were increased after hospital global budget introduced to 2004, and the growth were slowed down in 2005. The drug costs of inpatients over 65 years old were increased 2001-2009, and the growth range were greater for inpatients over 85 years old. Inpatients over 85 years old who admitted to central division and non-profit district hospital tended to have greater growth rates in lengths of stay 2001-2004. Inpatients over 85 years old who admitted to eastern division and non-profit district hospital tended to have greater growth rates in medical expense 2001-2004. The growth of lengths of stay and medical expense were slowed down in 2005. Conclusion : The growth range of medical utilization and expense were increased from hospital global budget to 2004. After introduced of the hospital quality of care ensure plan, the professional measures of hospital global budget program, the target cost control for ventilator-dependent patients,and the multirevised program for National Health Insurance program faced the third financial crises in 2005, the growth were slowed down. It’s necessary to draw up the DRG case payment schemes and the capitation payment system to control the increased of inpatient medical utilization and expense. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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