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Hospital response to a global budget program under universal health insurance in Taiwan

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  • Cheng, Shou-Hsia
  • Chen, Chi-Chen
  • Chang, Wei-Ling

Abstract

Objectives Global budget programs are utilized in many countries to control soaring healthcare expenditures. The present study was designed to evaluate the responses of Taiwanese hospitals to a new global budget program implemented in 2002.Methods Using data obtained from the Bureau of National Health Insurance (NHI) and two nationwide surveys conducted before and after the global budget program, changes in the length of stay, treatment intensity, insurance claims, and out-of-pocket fees were compared in 2002 and 2004. The analysis was conducted using the Generalized Estimating Equations (GEEs) method.Results Regression models revealed that implementation of the global budget was followed by a 7% increase in length of stay and a 15% increase in the number of prescribed procedures and medications per admission. The claim expenses increased by 14%, and out-of-pocket fees per admission increased by 6%. Among the hospitals, no coalition action was found during the study period.Conclusions In the present study, it appears that hospitals attempted to increase per-case expense claims to protect their reimbursement from possible discounts under a global budget cap. How Taiwanese hospitals respond to this challenge in the future deserves continued, long-term observation.

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  • Cheng, Shou-Hsia & Chen, Chi-Chen & Chang, Wei-Ling, 2009. "Hospital response to a global budget program under universal health insurance in Taiwan," Health Policy, Elsevier, vol. 92(2-3), pages 158-164, October.
    • Handle: RePEc:eee:hepoli:v:92:y:2009:i:2-3:p:158-164
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    1. Chu, David K.W., 1992. "Global budgeting of hospitals in Hong Kong," Social Science & Medicine, Elsevier, vol. 35(7), pages 857-868, October.
    2. Edward C. Norton & Courtney Harold Van Houtven & Richard C. Lindrooth & Sharon‐Lise T. Normand & Barbara Dickey, 2002. "Does prospective payment reduce inpatient length of stay?," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 377-387, July.
    3. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    4. J Hurley & J Lomas & L Goldsmith, 1996. "Physician Responses to Global Physician Expenditure Caps in Canada: A Common Property Perspective," Centre for Health Economics and Policy Analysis Working Paper Series 1996-12, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    5. Yue-Chune Lee & Ming-Chin Yang & Yu-Tung Huang & Chien-Hsiang Liu & Sun-Bing Chen, 2006. "Impacts of Cost Containment Strategies on Pharmaceutical Expenditures of the National Health Insurance in Taiwan, 1996–2003," PharmacoEconomics, Springer, vol. 24(9), pages 891-902, September.
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    3. Shin‐Yi Chou & James A. Dearden & Mary E. Deily & Hsien‐Ming Lien, 2020. "Provider responses to a global budgeting system: The case of drug expenditures in Taiwan hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1270-1278, October.
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    5. Kamhon Kan & Shu-Fen Li & Wei-Der Tsai, 2014. "The impact of global budgeting on treatment intensity and outcomes," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 311-337, December.
    6. Patrick Opiyo Owili & Miriam Adoyo Muga & Ya-Ting Yang & Yi-Hsin Elsa Hsu, 2019. "Perceived Impact of Taiwan’s National Health Insurance Allocation Strategy: Health Professionals’ Perspective," IJERPH, MDPI, vol. 16(3), pages 1-12, February.
    7. Bradley Chen & Victoria Y. Fan, 2015. "Strategic Provider Behavior Under Global Budget Payment with Price Adjustment in Taiwan," Health Economics, John Wiley & Sons, Ltd., vol. 24(11), pages 1422-1436, November.
    8. Li Xiang & Zhengdong Zhong & Junnan Jiang, 2022. "The Response of Different-Levels Public Hospitals to Regional Global Budget with a Floating Payment System: Evidence from China," IJERPH, MDPI, vol. 19(23), pages 1-11, November.
    9. Pu, Christy & Lee, Miaw-Chwen & Hsieh, Tsung-Che, 2023. "Income-related inequality in out-of-pocket health-care expenditures under Taiwan's national health insurance system: An international comparable estimation based on A System of Health Accounts," Social Science & Medicine, Elsevier, vol. 326(C).
    10. Pi-Fem Hsu, 2014. "Does a global budget superimposed on fee-for-service payments mitigate hospitals’ medical claims in Taiwan?," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 369-384, December.
    11. Shao-Wei Yang & Kuo-Chung Chu & Victor B. Kreng, 2021. "The Impact of Global Budgeting on the Efficiency of Healthcare under a Single-Payer System in Taiwan," IJERPH, MDPI, vol. 18(20), pages 1-14, October.
    12. Rotileanu Adina & Onişor Lucian-Florin, 2021. "Private health insurance customer satisfaction. A consumer behavior exploratory study based on structural equation modeling," Proceedings of the International Conference on Business Excellence, Sciendo, vol. 15(1), pages 650-663, December.
    13. Chang, Shun-Chiao & Lin, Chi-Feng & Yeh, Ta-Chun & Chang, Chun-Wei, 2019. "Determinants of the performance of traditional Chinese medicine clinics in Taiwan," Health Policy, Elsevier, vol. 123(4), pages 379-387.
    14. Cheng, Shou-Hsia & Chen, Chi-Chen & Tsai, Shu-Ling, 2012. "The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: A population-based study," Health Policy, Elsevier, vol. 107(2), pages 202-208.
    15. Hung-pin Lai & Meng-Chi Tang, 2018. "Hospital efficiency under global budgeting: evidence from Taiwan," Empirical Economics, Springer, vol. 55(3), pages 937-963, November.
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