Effects of Physician Affiliation on Utilization of Medical Resources : A Study of Diabetes Mellitus Outpatient

• Main Authors: Ming-Chung Chen, 陳明君
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2001
• Online Access: http://ndltd.ncl.edu.tw/handle/78870778331687895323

碩士 === 國立陽明大學 === 醫務管理研究所 === 89 === Since the implementstion of the National Health Insurance(NHI)in March 1994,health expenfiture of Taiwan has grown from 158 billion NTD in 1995 to near 300 billion NTD in 1999.Rapid increase in health expenditure has speeded up the improvement of payment system,and these improvementsdeeply enfluenced financial viability of all kinds of hospital.This study aims at analyzing cost components of treating NHI patients who have chronic diseases,Diabetes Mellitus(DM)outpatinet are used as studying subjects.Results of this study focus on discussing future improvements in payment system and effect of changing payment system on hospital financial viability. More than 700,000 DM Outpatient expense data of the year 2000 were studied and analyzed.These data including DM outpatients,whose diagnosis in ICD-9-CM were 250 or 259,expenses files and order files.These files were sorted and merged to created final database for statistical analysis. Result of statistical analysis indicate that physician who affiliated to different hospital characteristics,including accreditation status and practice in different places,had practiced differently.Physicians practing in hospitals with higher accreditation status were found to charge more than those doctors who worked for hospital with lower accreditation status.In addition,physicians who practiced in multiple sites were found to charge higher than whom only practice in single site. Two health policy implications were also propose:that the NHI Bureau should re-consider: 1.how reaseanable is existing payment difference among hospital with different accredition status,and 2.how physicians who practiced in various sites should be audited. Any improvement of these policyimplications above will result in preventing"economical reference."