| Summary: | 博士 === 國立臺灣大學 === 醫療機構管理研究所 === 98 === Background:From a disease standpoint, health promotion models are installed by medical facilities in order to reduce disease prevalence and mortality, effectively improving health quality. For many years, medical costs have increased without significant improvement in health promotion. Experts have pointed out that many intervention programs emphasize too much on service process improvement, customer service, quality improvement, yet failed to make a customer-based approach. New promotional concepts and methods have been suggested, letting the hospitals play an important role in health promotion, disease prevention and rehabilitation services, which shifts their responsibility from backstage caretaker to forefront promoter. This concept originated from the WHO Ottawa Charter for Health Promotion. For treatment-oriented medical facilities, their major financial resource comes from payment policies or pay-for-performance programs. As more hospitals enter the Diagnosis Related Group (DRG) system, changes in medical environment brought by the rapid development of information technology and the pressure on improving healthcare quality from evaluation systems have strongly affected hospital management policies. In the increasingly competitive medical business, the goal should be to combine healthcare service with clinical medicine and to achieve one’s best interests by maintaining the balance between finance and supply. The healthcare system should be re-designed to establish a customer-oriented business case for health promotion.
Goals:The main goal of this study is to compare the effects of the Health Improvement Intervention Program (HIIP) on recipients and non-recipients. Improvements in health status and reciprocal financial benefit will be evaluated. From an organizational viewpoint, a better understanding of its impact on healthcare management and financial return can be gained. If there’s no immediate financial return on investment (ROI), the ability to provide non-financial returns may be used to measure the value of organizational function and sustainable development.
Methods:In this retrospective cohort study, we collected the health examination data between 2004 and 2009 from one medical center in Taipei. All subjects underwent two complete exams with a time gap of three years. The baseline and follow-up data were compared between recipients and non-recipients of HIIP. These included laboratory data, risk scores, examination costs, outpatient clinic referrals, and satisfaction index. Differences between the two groups were analyzed with the before-and-after method using descriptive statistics, inferential statistics, propensity score (PS), and difference-in-difference (DID) methods. Non-financial aspects included health status analysis and satisfaction index. Financial returns gained from outpatient clinic referrals were analyzed from cost and profit rates, then calculated with risk-adjusted discount rates to produce the net present value (NPV) for individuals and the intervention program facility.
Conclusions:Both groups (intervention vs non-intervention) showed improvement in all risk factors except systolic blood pressure, postprandial glucose and HDL (p value<0.001). Difference tests between groups also showed significant improvement (p value<0.001), meaning that HIIP improved all recipients’ health status after three-year follow-up. To avoid errors caused by randomization between common variables, propensity score (PS) was used to perform matched analysis. All variables with significant difference before matching showed no significant difference after matching. This indicated that the baseline data of both groups were of homogenous distribution, which would minimize any errors. Difference tests between baseline and follow-up after matching showed improvement in BMI (p value<0.05), fasting glucose (p value<0.01), eGFR (p value<0.01), total cholesterol, HDL, LDL, ATP III (p value<0.001). DID analysis was used to remove any confounding effects caused by biological or other factors. The results (F=266.39, Adj R-Sq=0.6939) showed no significant difference between the two groups at baseline. While the non-intervention group showed no difference between baseline and follow-up, the intervention group showed significant improvement at follow-up, especially in metabolic syndrome scores. This suggests that the HIIP is an efficient intervention program.
In cost-benefit analysis, the long-term medical cost for non-recipients was much higher than recipients. After adjusting with discount rate, the calculated total NPV was 15661.63 dollars. In other words, this intervention program yielded a positive NPV, suggesting that it’s a good business case for the participants.
Non-financial evaluation based on customer satisfaction surveys yielded a top score for nursing service (92.85%), followed by the desire for repeat exam (91.1%) and overall satisfaction index (90.05%). All other indices also scored higher than the 85% threshold. This suggests the intervention program business case can be beneficial for sustainable development.
In organizational profit analysis, hospital income from outpatient clinic comprised of 44.28% total, emergency department 4.91%, hospitalizations 50.81%. Outpatient referral from HIIP increased by each year between 7 to 8.5 million; profit margin was also as high as 4 million. From 2004 to 2009, the direct economic benefit was 19,522,596.13 dollars.
In conclusion, the Health Improvement Intervention Program has a positive ROI on the participants’ health status promotion. It can also reduce individual medical costs. As for economic benefits on the medical facility, outpatient clinic referrals can bring significant profit. In non-financial observation, the high satisfaction scores yielded from customer surveys show that this program can be utilized for sustainable development.
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