The Impact of Co-payment Adjustment on Medical Utilization of Hypertensive disease Outpatient visits

• Main Authors: Lu-Yin Chen, 陳陸英
• Other Authors: Timothy-Tingson Wang
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/55202357185076853894

碩士 === 國立東華大學 === 國際企業學系 === 97 === The Bureau of National Health Insurance (BNHI) had raised co-payment of outpatient, in an attempt to correct patient’s attitude in medical utilization since July 15th, 2005. BNHI wishes to lower outpatient number in large hospitals by shifting patients to local hospitals or clinics. According to statistic of prevalence of Hypertension from Department of Health, Executive Yuan, ROC, in 2007, the total amount of Hypertension in outpatient is 2.63 million, 1.33 million is female and 1.30 million among the total. The amount of outpatient is about 13 million and 20 thousand which costs 14.9 billion NT dollars. Medical service ratio which concentrates in south and east area is about 19.2 to 19.6 times. Hypertensive disease is a common chronic disease in adults which requires treatment continuously to control the symptoms. This research will discuss effect of adjustment of co-payment to Hypertensive-disease patients’ Medical utilization and patient behavior. The research data is secondary date offered by Eastern Region Branch of the Bureau of National Health Insurance. This research divides into two parts. The first part was designed as pre- and post-test from August to December of 2004 and 2005 in 5 district and above hospitals choosing from eastern area. Moreover, during the research, patients who went to hospital were separated into 5 groups, burden groups, low-income groups, veterans groups, indigene groups and disablement groups, and observe the effect of adjustment of co-payment to hypertensive-disease patients’ medical utilization. In the second part, choosing patients from 5 district and above hospitals in the durations of August to December of 2004 to 2008 and observing medical utilization and patient behavior change of the same group of cases of hypertensive disease patients before and after co-payment adjustment. Effects of Medical utilization of Hypertensive disease patients in 5 districts and above hospitals of eastern area before and after the adjustment of co-payment on July 15, 2005 are as follow: 1. Overall effect: Since co-payment had been adjusted on July 15, 2005, the number of hospital visits had reduced by 390 and down to 1,692 with percentage of 19%. The decreased ratios of male and female are similar. 2. Effects on number of hospital visits by group: i. Except the number of hospital visits of female of indigene groups and male of disablement groups increased, all the other groups decreased. The groups with most drops are male in burden groups, the meridian of life in 50-50 year-old group, first category in insurance group and insurance fee between 17,281 and 22,800. While, group with age of 50-59 in low-income groups and age less than 49 in disablement groups did not affect by co-payment adjustment. The number of hospital visits kept still. ii. In the hospital levels, indigene groups and veterans groups showed the percentage of the most significantly decreased number of hospital visits of -40% and -22.04%, respectively. iii. In hospital ownership, public hospitals and private hospitals dropped 58.22% and 25.06% were the most. 3. Effects of the number of hospital visits on groups: male and female both dropped most in burden groups with percentage of -5.89% and -4.78% respectively which showed strong control. Male and female increased most in disablement groups with percentage of 8.65% and 18.6% respectively, which showed less control on it. The burden groups dropped most (-5.39%) in four hospitals in Hualien County. The other groups dropped or increased with percentage of -1.04% to 10.61%. Low-income groups decreased most (-33.33%) in one hospital in Taitung County. The others were between -0.26% and 20%. 4. The average day of medication prescribed, after co-payment adjustment, only affect female in indigene groups with reduction of -1.85 days, the other groups had obviously increases. Male in indigene groups increased 3.97 days and female in disablement groups increased 2.99 days were the most. The average payment of outpatient in low-income groups increased more than burden groups. In addition to, veterans groups showed increase only in Medical Center. 5. Analysis of different cases: 04 (Chronic cases), after co-payment adjustment, had strong control (-4.8%) only on the number of hospital visits of burden groups. All the other increased, disablement groups increased 12% was the most. More over, 09 (Other cases) showed slightly control on the number of hospital visits of burden groups, low-income groups and veterans groups, while the others increased. Observation duration of 5 years included before and after co-payment adjustment on July 15, 2005 (from 2004 to 2008, 5 months per year). Effects of medical utilization and patients behavior of Hypertensive disease patients are as follow: 1. The result showed, after co-payment adjustment, the amount of hospital visits in burden groups decreased continuously in the following 4 years, which showed strong restraint in this case. It had largest decrease in 2008(-6.62%) 2. Low-income groups, after co-payment adjusted, only increased in 2006 (6.49%). The rest three years dropped significantly. 2007 showed the greatest drop especially (-25.61%). 3. Veterans groups, after co-payment adjusted, dropped only in 2007 (-9.38%). The rest three years increased. It had greatest increase especially in 2008 (5.85%). This case did not have significant difference. 4. Indigene groups, after co-payment adjusted,only increased in 2005 (5.75%). The rest three years decreased, especially with greatest drop in 2007 (-4.39). 5. Disablement groups, after co-payment adjustment, dropped -1.74% only in 2006. The rest three years showed increase. It had greatest increase of 11.42% in 2005. This case also did not have significant difference. Based on the above results, the result showed that the number of hospital visits in burden groups had decrease year by year. Four year after the co-payment was adjusted, the medical utilization reduced about 25%, which showed the effect was continuous. Besides, after the Bureau of National Health Insurance drove “the improve plan of medical payments of high blood pressure”, the effects on disablement groups were more significant. After co-payment in Taiwan has been adjusted several times, it whether achieve the control of necessary medical cost or not, and further affected medical effects and healthy. National family pays the cost of medical expenses ratio increased year by year until 37% in 2007. This was similar to the situation before Health Insurance held which was 41%. It was worthy to further discuss whether accessibility and fairness of Health Insurance changed.