The Impacts of Regressive Physician Payment Policy on the Utilization and Expenses of Ambulatory Care for Medical Center and Regional Hospitals in Taiwan

• Main Authors: SHIH-CHIEH WU, 吳時捷
• Other Authors: 薛亞聖
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/85157790524869651206

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 92 === Abstract Regressive Physician Payment Policy has been put into practice since 1st,January 2001.The policy aimed at decreasing the growth rate of ambulatory care patients and increasing the time doctors can give outpatients by decreasing the number of patients. The purpose of this research was to understand the impacts of Regressive Physician Payment Policy on the utilization and expenses of ambulatory care for medical center and regional hospitals in Taiwan. This study was a natural experiment. It observed three years before and after the introduction of the Regressive Physician Payment Policy for medical center and regional hospitals. It was a case-control study in order to eliminate the effects of confounding factors. The study group was the Medical Center which executed Regressive Physician Payment Policy. The control group was the Regional Hospitals which did not executed Regressive Physician Payment Policy. This study used claimed data of Nation Health Insurance and Department of Health from1999 to 2001 for analysis. The “difference-in-difference” methodology and polynomial regression were used for statistic analysis. The following are the results of this study: 1. After Regressive Physician Payment Policy was put into practice ,the number of patients of medical center and regional hospitals still increase. There’s no significance between the study group and the control group by polynomial regression. Regressive Physician Payment Policy did not decrease growth rate of ambulatory care patients. 2. After Regressive Physician Payment Policy was put into practice, medical center and regional hospitals diagnosis fee still increase. But the growth of rate was slow. There’s significance between the study group and the control group by polynomial regression. Regressive Physician Payment Policy decrease the growth rate of diagnosis fee. 3. After Regressive Physician Payment Policy was put into practice, medical center and regional hospitals treatment fee and drug fee were still increase. There’s no significance between the study group and the control group by polynomial regression. Hospitals did not make up the loss of diagnosis fee by increasing treatment fee and drug fee. 4. After Regressive Physician Payment Policy was put into practice, medical center and regional hospitals total ambulatory care expenditure were still increase. There’s no significance between the study group and the control group by polynomial regression. Regressive Physician Payment Policy did not decrease total ambulatory care expenditure. 5. After Regressive Physician Payment Policy was put into practice, medical center and regional hospitals still increased hospital beds. The growth rate was slow. 6. After Regressive Physician Payment Policy was put into practice, medical center and regional hospitals still increased physicians. There’s no significance between the study group and the control group by polynomial regression. Hospitals did not increase physicians under Regressive Physician Payment Policy. This study found that medical center and regional hospitals still increased ambulatory care patients under Regressive Physician Payment Policy. Because the increase ambulatory care patients can bring treatment fee ,drug fee as well as the increasing the definition of reasonable loads for outpatients; therefore, even if the diagnosis fee will be decreased to 120 points when the reasonable loads for outpatients go beyond, hospitals still increased ambulatory care patients. Regressive Physician Payment Policy can not attain its goal. This study suggested that: (1) To avoid “Expectation Effects” and to increase ambulatory care patients, current formula should be changed so that it can be used by each hospital to set up the reasonable growth. (2) In order to encourage hospital to take care of serious patients, and to decrease the growth rate of ambulatory care patients, longer duration of medicine for chronic diseases should be encouraged and paid unit of emergency cases and hospitalization should be adjusted.