| Summary: | 碩士 === 東海大學 === 工業工程與經營資訊學系 === 104 === “Limited health care resources but unlimited demands" is a challenge the National Health Department constantly faces。In addition to promote the diversification of the various payment systems, the Department invites medical professionals to reviews fee applications according to the "National health insurance medical service fees review regulations" on a quarterly basis, and questionable fee applications will be waived until further clarification (appeal) is provided by the applying hospital.How to complete the appeal process as soon as possible in order to get the most possible pay is an issue of tremendous importance for medical administrators.
In this study, a system simulating reassignment of medical divisions covered by responsible staff involved in the appeal process for waived health insurance fee was used to investigate the time required for the process。After making adaptions based on the simulation results,it was revealed that the the time requirement of the appeal process is significantly reduced from 28.6 hours in the present system to 6.9 -12 hours, or 6.9 hours(a reduction of 58% to 75%) This new method can facilitate the hospital to complete the appeal process as soon as possible and receive the most possible pay.
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