Study of the Management Change of Primary Care Clinics toward the Implementation of Increase in Co-payment for Hospitals

• Main Authors: Liang-Chin Chiu, 邱良進
• Other Authors: 張永源
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/92429870701274654029

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 94 === Objective：Since the implementation of the National Health Insurance（NHI）, health care expenditure is rapidly increasing, especially outpatient services. The implementation of increase in co-payment for hospitals refers to patients for ancillary services. The aim of this research is to explore the changes on the quantity of outpatient medical service of clinics and on physicians’ practices, management strategies, satisfaction in the same half year before and after the implementation of increase in co-payment for hospital being inaugurated by analyzing the objective claim data and physician’s subjective questionnaire data in Kaohsiung city. Materials and methods ：Bureau of National Health Insurance Kao-Ping Branch’s File of Outpatient Medical Expense was employed among primary care clinics in Kaohsiung city from August,2004 to January,2005 and August,2005 to January,2006. The other, a total of 1049 clinic practitioners registered in Kaohsiung City Medical Association at 2004 were investigated by questionnaires. All of the objective and subjective results are used to compare the changes about the claim data and physicians’ practices, management strategies, satisfaction toward the implementation of increase in co-payment for hospitals by statistical analysis using the SPSS 10.0 for Windows. Results：In objective claim data, the average of pharmacies expense increases significantly after implementation of increase in co-payment for hospital ,but the quantity of other medical services, the average of medical expense and the average of total medical expense do not change significantly. In physician’s subjective questionnaire data, a total of 1049 questionnaires were sent to clinics and 306 questionnaires were completed. The response rate is 29.2 ﹪. 306 questionnaires were in physician’s presence and 104 questionnaires were completed. The response rate is 31.5 ﹪. More than 50﹪ physicians answer 「no change」to most evaluation items in the questionnaire. But All physicians answer 「decrease」to physicians’ satisfaction items in the questionnaire. And there are significant correlations between evaluation items and six physician’s characteristics including age, sex, educational background , total years of operation, professional expertise and the number of physicians in clinic after taking the questionnaire data into Gamma statistic or chi-square test. Conclusions and suggestions：The effects after implemention of increase in co-payment for hospital on clinic physicians’ practices and management strategies do not change according to the questionnaire data, but physicians’ satisfaction is decreased . And in objective claim data, the average of pharmacies expense increases significantly, because the floating values of pharmacies is 1.0. Since period under the study is short, so longer period used for the questionnaire survey is highly suggested .