Economic behavior of medical clinics under global budget floating point system

• Main Authors: Wang Cheng Yu, 王政裕
• Other Authors: CHEN CHIN-SHYAN
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/98920626167079876793

碩士 === 國立臺北大學 === 經濟學系 === 97 === After the implementation of National Health Insurance (NHI), the total medical expenditure increased rapidly, the financial burden became a serious problem for the operation of NHI. In order to control the growth of medical expenditure, NHI started to employ the global budget payment system. Under the global budget, the payment was retrospective, the final payment received was calculated by the value of floating point. After the execution of global budget system, the value of floating point continuously dropped in the medical clinic sector. However, the value started to rise back since Q4 of 2005. As there is no major change in the global budget system and the overall medical environment, there must be other change occurred. The aim of this study is to explore the behavior of medical clinics when facing the global budget payment system and try to figure the causes of value variation. In this paper, we employ both the theoretical model and empirical data analysis. In the hypothesis of theoretical model, the medical clinic was assumed to pursue the maximum of income under the global budget floating point system. In the empirical section, the data was drawn from the National Health Insurance database and covered the application data of 2004, 2005 and 2006. Since the floating point system works on the quarterly and NHI branch basis, panel data regression was applied to this study. The descriptive statistics analysis was also utilized to see if there is any area difference and specific trend in the macro environment. The major findings of the theoretical analysis include: (1) the condition of income maximizing for individual clinic was not practically feasible because it need other clinics to stop their operations. (2) If the clinics achieve the agreement of sharing the budget evenly, there still exists the incentive for clinics to violate the agreement and make their own income higher. Thus, the value of floating points will decrease in this circumstance. (3) The value of floating point was also found to have a positive relationship with the motivation of increasing the points applied by clinics. Higher value encourange higher motivation of increasing application. In the empirical analysis section, we ascertained the value variation of floating point was significantly influenced by application case quantity and the number of medical clinics. Further, the phenomenon of value rising back mainly resulted from the decrease of application cases. The decrease of application cases was due to the reduced practice day in a month and smaller patient number a day. The above finding was supported by the official document of the medical clinic association and clearly revealed the influence of peer group. In the descriptive statistics, the area difference of application behavior was found to support the hypothesis of income maximizing in the theoretical model analysis.