| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 95 === Aim: To analyze changes in hospital claim behaviors in the psychiatric units after the adjustment of fee schedule by RBRVS in July 2004. Since the design of hospital’s payment system is closely tied to the allocation of medical resources, adjustments of the fee schedule pose the potential of altering physician behaviors as well as redirecting the track of medical human resources. Moreover, adjustment on the fee schedule could generate different claims behaviors by medical providers. The study embarks to analyze this issue by examining hospital’s psychiatric units where the relationship between physicians and patients is stable. The study is, based on a secondary data analysis on hospital claim behaviors before and after the fee schedule adjustment, to evaluate the causes for changes and to serve as recommendations for policy makers upon reforming fee schedule for other hospital units.
Method: Fee schedule adjustment of hospital’s psychiatric units in July 2004 is the focus of the study. Data used in the study is based on hospital claims, collected by the Bureau of National Health Insurance, before and after the change of fee schedule in psychiatric units. The analysis is divided into three parts: the first part examines the effect on psychiatric unit’s expense claims; the second part analyzes the effects from five dimensions as well as its effect on hospital behaviors; the last part explores the elements that affect different kinds of hospitals by Logistic Regression.
Result: In outpatient service, the increase of total expenses and special treatment expenses mainly came from the increase of patients. In inpatient service, most variation came from coping with the change of the fee schedule. The variation of the fee schedule in psychiatric units in July 2004 could be classified into five different types of changes: A). separated claim B) upgrading claim C) new claim D) degrading claim E) canceled claim. In hospital behaviors, the first type: most notable in public hospitals and hospitals in North and Kaoping area. For the second type, investigators need to pay close attention to behavior therapy under special treatment service items in these types of hospitals. The third type: most notable in hospitals that are coping moderately to the fee schedule change; in this type of hospitals, the investigators need to pay close attention to group psychotherapy and psychiatric nursing care. The fifth type: hospitals using separated claims and the seventh type: hospitals coping with upgrading claims both have the same characteristic where the ratio of psychiatric acute sickbeds is higher; Moreover, occupational therapy is also common preference in these types of hospitals.
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