Ownership and Hospital Behaviors

• Main Authors: Le-shin Chang, 張樂心
• Other Authors: Shou-hsia Cheng
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/77821008461643778090

博士 === 國立臺灣大學 === 衛生政策與管理研究所 === 92 === Ownership and Hospital Behaviors Abstract Objectives: According to property rights theory, we assume that for-profit hospitals pursue profit-maximization, and they are likely to be more efficient than those of not-for-profits or public hospitals. Therefore, medical services offered by for-profit hospitals could be less expensive. However, findings from previous studies were not conclusive, which may due to the complicated insurance and payment system, and relatively limited data in the Unite States. Under Taiwan’s National Health Insurance (NHI), hospital behavior agrees with the assumption of property rights theory. This study took the advantage and analyzed hospital behaviors such as medical fees, diagnosis and medication frequencies, and changing medication among hospital with different ownership, while various payment systems were also considered. Methods: Inpatient claim data filed in the period from January to March 2002 at all hospitals across the nation qualified as regional teaching hospitals and above were used; patients with six common principal diagnoses (i.e. diabetes, stroke, pneumonia, asthma, cesarean section, and appendectomy) were randomly selected. We distributed a structured questionnaire on medical fees and perceived quality to 17,798 selected patients. In order to study the switching medication behavior, another NHI database containing claim data of outpatient and inpatient in 2000 and 2001 were employed to examine the effect of fee schedule change in April 2001. Results: A total of 6,725 questionnaires for discharged patients were successfully completed with a respond rate of 46.7%. Results from regression analyses, showed that for-profit hospitals charged significantly higher out-of pocket, even adjusting for the price difference in ward types. For those diagnoses reimbursed by fee-for-service (FFS) system, public hospitals had the lowest claim expense, out-of-pocket, and total medical expense, and had longer average length of stay. We also found that for-profit hospitals adjusted their medical practice to best-fit different payment systems. For those diagnoses with fixed payments, their diagnosis and treatment items, quantity of orders, and medical fees are in general lower than their counterparts. For those diseases paid by FFS, for-profit hospitals used more diagnostic and treatment items, quantity of orders, and had higher claimed fees. However, concerning the medications, for-profit hospitals did not adjust medication usage to cope with different payment system. Interestingly, price-related switch-medication behavior was found in the study. Results from logistic regression model, showed that for-profit hospitals significantly changed the quantities of medication of different brands according to their price changes. For-profit hospitals obviously discontinued the use of those brands with bigger reduction rate in the NHI payment scheme, and shifted to other brands with smaller reduction. This finding revealed the possibility that for-profit hospitals might maximize their income through medication kickbacks. Conclusion: Under the National Health Insurance System, the tendency of for-profit hospitals pursuing maximized profit through charging higher out-of-pocket, changing frequencies of diagnostic and treatment orders according to payment methods, and switching medication brands based on drug profit more obviously than their counterparts. The need for government to monitor hospital behavior deserves further investigation.