Study of Payment Mechanisms, Physician Compensation Arrangement, and Physicians’ Behaviors - Repair of Inguinal Hernia

• Main Author: 宋霈蓁
• Other Authors: 溫秀英
• Format: Others
• Language: zh-TW
• Published: 2000
• Online Access: http://ndltd.ncl.edu.tw/handle/43819799713780896600

碩士 === 長庚大學 === 管理學研究所 === 88 === The purpose of research is to study how physicians’ compensation arrangements impact their behaviors under different payment mechanisms. The following issues would be addressed in this paper. (1) The studies of fee for service (FFS) and case payment impact hospital’s compensation arrangement and physicians’ incomes of services. (2) Health care intensity, expenditure and service volume under hospital physicians’ compensation arrangement of different payment mechanisms toward physicians’ health care behaviors. The sample of this research paper were selected from the patients with procedure of repair of ingunial hernia who were treated either through outpatient or inpatient services locations of Chang Gung Memorial Hospital in March to September of 1997, 1998 and 1999 at several locations of Chang Gung Memorial Hospital system, such as Keelung, Linko Shian, Taipei County and Kaohsiung. The analytical methods used in the study were descriptive, single variable and multi-regression analysis. As the example taken from Chang Gung Memorial Hospital, the results indicated that under two different payment mechanisms, FFS and case payment, the hospital implement different compensation designs which truly influenced physicians’ clinical behaviors. Two major findings were (1) Medical reimburse amount from the Bureau of National Health Insurance (BNHI) were higher in case payment than in FFS system and hospital obtained more revenue alone with physicians’ incomes of services. Meanwhile, physicians’ incomes of services and health care intensity, expenditure and service volume were manifested significant positive correlation. (2) In the case of lateral repair of inguinal hernia under case payment system, it showed the intensity of services provided by physicians were declined as well as X-Ray examinations, treatments, surgeries and total orders and inpatients’ average length of stay. On medical cost aspect, expenses of surgery procedures, operation materials, wards and pharmaceutical were all decreased. On the other hand, the case of bilateral repair of inguinal hernia did not show significant difference in service volume or any clinical procedure. The results of this study were limited to single health care organization and procedure of disease. We are working further to expand our research issued and samples, different levels, types and ownership of hospitals and different kinds of diseases will be addressed more. In addition, health care quality will be considered in the perspective research as well in order to obtain more objective and thoughtful findings of how payment mechanisms impact health care quality.