The Study of the Responses of the Clinics to the Change of National Health Insurance Reimbursement System

• Main Authors: Ying-Chia Huang, 黃英家
• Other Authors: Shang-Ping Lin
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/93103203385942651828

博士 === 國立雲林科技大學 === 管理研究所博士班 === 93 === There were just a few studies about organizational strategic responses to the impact of the institutional change in the past. Lack of documentation of strategic decision-making, the empirical studies about small enterprises’ strategic responses to environmental change are few. Comparing to the cross-section studies, we designed a quasi-experimental cohort framework to establish a cause-effect analysis of the institutional change and organizational strategic responses. This study focused on the primary care industry of Taiwan, and based on the context of the National Health Insurance (NHI) program and the Global Budget Reimbursement System. Dividing the private clinics into 5 groups by their average outpatient visits in 2001, this study traced the responses of private clinics to the change of 2002 NHI reimbursement schedules for 31 months. Borrowing the survival analytic tools from the epidemiological methods, such as Kaplan-Meier curves and Cox proportional hazard models, the study compared the trends and the relative hazard rates between the groups based on environmental attributes and the characteristics of clinics and their owners. The results revealed that more clinics with higher volume of outpatient visits adopted ‘one more doctor’ or ‘an affiliated pharmacy’ strategy. Though there was no difference in adopting ‘one more doctor’ strategy among different jurisdictions, clinics in Central and Kaoping jurisdictions adopted ‘an affiliated pharmacy’ strategies half less than those in other jurisdictions. There was either no difference among clinics in rural or urban areas in adopting ‘one more doctor’ strategy, but less clinics in metropolitans and cities adopted ‘an affiliated pharmacy’ strategy than those in rural areas. Dividing the clinics into three groups by the monthly claims of Treatment Fees (TF), it revealed that the middle TF group adopted ‘one more doctor’ strategy, and the low TF group adopted ‘an affiliated pharmacy’ strategy more than other groups. Group-practice clinics were 3.3 times more than those sole-practice ones to adopt ‘one more doctor’ strategy, but 30% more in using ‘an affiliated pharmacy’ strategy. According to the ages of the clinic owners, it found that younger and middle cohorts were 3.6 and 1.6 times more than elder one in adopting ‘one more doctor’ strategy, but only 56% and 33% more in using ‘an affiliated pharmacy’ strategy. Clinic owners graduated from Taiwan’s medical schools adopted ‘an affiliated pharmacy’ strategy more, but used ‘one more doctor’ strategy less than the others. There was no gender difference in strategic adoption. There was more detail analysis of organizational isomorphism, inertia, and environmental niche in the discussion.