| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 95 === Background
In July 2004, a“Center of Excellence Initatives（CEI）”of hospitals was implemented by National Health Insurance（NHI）. CEI guaranteed the provision of fixed budget subject to the hospital fulfilling its commitments in terms of both quantity and quality of its services ,in which hospitals participated on a voluntary basis.In response to the limited growth on budgets, would hospitals’and physicians’change behaviors in order to control costs of treated or make more profits？
Objectives
The purpose of this study was to explore how CEI could influence hospitals’and
physicians’behavior.The goal of this study was to answer the following questions：1.Could CEI influence hospitals’and physicians’behaviors？
2.Was the influence different according to the hospital’s unique characteristic?
3.Did physician’s characteristic influence his medical behavior？
Materials and methods
This study used a cross-sectional,naturally experimently control group design.The study population were psychiatrists in national base.The intervention groups were hospitals which participated in CEI . We investigated behavioral changes of the intervention group, and compared with the control group during and after CEI. The screening criteria included psychiatrists who worked at the same hospital more than two years. There were 637 psychiatrists were included.The questionnaire, designed by the researcher, was mailed to them. The result was keyed into computers for analysis,
we used multiple regression to assess the impacts of CEI.
Results
1.There were 80 responsers in the study, and the response rate was 12.55％.
2.Hospitals in CEI were more likely to enforce internal management policy to reduce the budget or costs.
3.Psychiatrist in CEI hospitals was more likely to reduce cost of clinical service.
4.Impacts of CEI on Hospitals’ and Physicians’ behavior varied among the different regions. Compared with hospitals in Taipei region, hospitals in Southern region were less likely to control their medical expenditure. And phycians in Northern region were less likely to change their presciprtion items because of drug price.
5.Physician’s own characteristics did influence his medical behaviors: elder than 41 years old, more than 6 years of service expeirnce, and patients-care numbers more than 6 beds in acute ward were more likely to change their prescription items to reduce drug fees and their service cost
Recommendations
Policy recommendations
1.Set up quality monitor indication for protecting the medical rights of patients
2.Regularly check and monitor physicians’ prescription behaviors
3.Implementation of OPD/IP ratio gradually should reflect the baseline differences among various hospitals
Hospital recommendations
1.Medical cost management
2.Enhance the patients’ (or caregivers) drug education for preventing from providers’ perverse medical behaviors
Future researchers
To evaluate the impact of behavioral change either in hospital or physician level on healthy status, disease outcome, and quality of life of the patient.
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