An Evaluation into the Effectiveness of Launching the Independent Management System in Hospitals - A Case Study of Hospitals Under the Authority of the Bureau of National Health Insurance, Tapei Branch

• Main Authors: Shu-mei Li, 李淑美
• Other Authors: Shu-ling Chiang
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/19578170467776719073

碩士 === 東吳大學 === 會計學系 === 93 === Abstract Purpose： The present study aims to evaluate the outcomes of introducing an independent management system which was put in place to launch a global budget scheme in hospitals. The outcome of this scheme was evaluated with reference to (1) the observed commitment shown by each participating hospital to the proposals which they had formulated for the Hospital Excellence Program and (2) the opinions put forward from different sectors after the launch of the scheme. Twenty-five hospitals participated in this study, all of which are under the control of the Bureau of National Health Insurance (Taipei Branch). The changes in (1) the total number of medical service cases and in (2) the total medical resource distribution, before and after applying the scheme were compared. Based on the results of this study, we propose suggestions, that the chief government organisation can refer to, in order to draw up a strategy for strengthening the independent management scheme Method：Data for the current study was collected from 6 medical centres, 10 regional hospitals and 9 district hospitals giving a total of 25 participating hospitals. Average figures for each of the areas examined in this study, from each participating hospital, were obtained from data collected between July and December in the years 2002 and 2003 (before the scheme was implemented) and these figures were compared with data obtained between July and December, 2004 (after implementation of the scheme). A comparison between these two periods thus indicated any differences that were a result of the scheme. The SAS 9.0 and EXCEL 2002 programs were used to perform an analysis of the raw data and to provide descriptive statistics. The WILCOXON Signed Rank Test was then applied to the data in order to examine the differences in (1) the total number of medical service cases of outpatient and hospitalization service, (2) medical resource distribution and the quality of care for acute, rare or critical medicine patients. Results：In the general area of medical service, the number filed cases in both outpatient and hospitalisation service was increased significantly. The study showed that after participation in the scheme the points of medical expenditure in the outpatient service decreased significantly, while points of inpatient cases increased significantly. However, there was still a big gap between the current situation and the target ratio (outpatient service : hospitalization = 45% : 55%). The points of medicine expenditure for outpatient and inpatient service were increased significantly, though it showed a significant decrease within the proportion of the total medical expenditure. It still occupied 28.82% of the total medical expenditure, which is 14% higher than average in OECD countries. In the “encouraged items” of global budget scheme, only outpatient operation cases showed significant increase in the points and occupancy. In the areas of total medical resource distribution and acute and critical medicine expenditure distribution, a comparison among level A, B and C hospitals’ caring system indicated that only hospitals in level A showed a significant decrease in the number of medical care cases, whereas hospitals in levels B and C did not show a difference. In addition, there was no significant difference in the disease variety treated in the different levels of hospitals, that is, the roles and functions of the different levels of hospitals were still ambiguous. In the area of acute and critical medicine patient care, points of medical expenditure and occupancy showed a significant increase. Conclusion：The purpose of this study was to evaluate the hospital independent management system. The results of this study indicate that the structure of outpatient service and hospitalization filed cases were better than before participation in the scheme. The proportion of total medicine expenditure in the outpatient service and hospitalization also showed significant decline after participation. At the same time, there was an obvious improvement in acute and critical medical patient care. Nevertheless, the range of changes was limited. Moreover, after participation, from the functional points of view, the system was barely satisfactory in the area of medical resource distribution. Overall, the outcome of this scheme is unsatisfactory. Key words：global budget scheme、hospital excellence program、hospital independent management system