The Effect on Expenditure between Outpatient Services and Hospitalization for non-enrolled Center of Excellence?Examples of Bureau of National Insurance the Central Region Branch

[[abstract]]The purpose of this study is to explore the influence on the ratio of inpatient and outpatient expenses for the hospitals that do not participate in the ?Center of Excellence Plan?. Based on the health insurance excellent plan implemented as from July 1, 2004 for comparison, the data of 1 branch medical center in central area, 5 regional hospitals, and 61 district hospitals for a total of 67 hospitals that do not participate in the Center of Excellence plan were targeted for statistic analyses. Following are the major positivist findings of this study: 1. There was no significant variance at the ratio of outpatient and inpatient points at various levels of hospitals after the implementation of the health insurance Center of Excellence plan. The variation level was within 2%. For regional hospitals, the ratio remained the same during the pre and after the implementation. It represents that all levels of hospitals do not adjust their ratio of outpatient and inpatient service with internal control measures. It also illustrates that those hospitals that do not participate in the Center of Excellence plan do not change their medical behavior even though the institution of the goal ratio. In other words, they do not use internal control measure to adjust the ratio of outpatient and inpatient service. 2. For the only medical center that does not join the Center of Excellence plan in central area, although its outpatient cases and points showed decline after the Center of Excellence plan, its inpatient cases and points were presented with rising trend, and the ratio was over 5%. It illustrates hospital?s intention to adjust its ratio of outpatient and inpatient service through internal control measures. Even though there is pressure for regional and district hospitals for the ratio of inpatient and outpatient expenses, in order to grab a piece of pie generated from the Center of Excellence plan, they can not help taking measures. One thing worth noting is that whether the limitation of outpatient service for the Center of Excellence plan participating hospitals forces some patients to transfer to the non-participating hospitals resulting in the addition to the non-participating hospitals? If this is the case, are there any patients being rejected for medical treatments? Whether the public medical care rights are affected? All of them are the issue that the health competent authorities shall deliberately explore. 3. Except for the medical center where the medicine expenses for outpatient service has dropped off, the average medicine expenses for outpatient service at regional and district hospitals have actually shown an upward trend after the implementation of the Center of Excellence plan, and the increase rate is 21% and 27% respectively for regional and district hospitals. Among the increased outpatient points, 50% of them are medicine expenses at the regional hospitals whereas 49% at the district hospitals. It indicates that those hospitals that do not join the Center of Excellence plan are less likely to give strict control over medicines. Since fixed points are used for the medicine cost and the hospitals can get some benefit from the medicine price difference, it is quite possible that hospitals may profligately prescribe medicines trying to get some profits. 4. Following the implementation of the Center of Excellence plan, other than the medical center where the points of inpatient operations remain the same, the outpatient and inpatient operation points as well as cases in other various levels of hospitals all show upward trend, and there is also no significant change on the transfer from outpatient operations to inpatient operations. However, it is noticeable that while both outpatient operation points and cases are on the rise, whether the increased points and cases at the non-participating hospitals are resulted from the transfer of the patients who are rejected by the Center of Excellence plan participating hospitals due to patient quota being full, or whether it is the supply inducing demand (SID) phenomena initiated by the hospitals. It means to induce patients to take unnecessary operations. It is also an issue required in-depth investigation by the health competent authorities