Quality of Healthcare and Related Factors Before and After the Implementation of Hospital Global Budget Payment System

[[abstract]]Abstract Introdution: Hospital Global Budget Payment System has been executed since July, 2002. Although the execution of Hospital Global Budget Payment System can efficiently control the medical expenditures, hospitals and clinics might become the cause of lowering the healthcare quality by controlling costs further. Therefore, it is necessary to study and comprehend the changes of healthcare quality of hospitals and analyze the related factors before and after the execution of Hospital Global Budget Payment System. Purpose: Be aware of the changes of healthcare quality of hospitals and the related factors before and after the execution of Hospital Global Budget Payment System based on the quality indicators of hospital global budget healthcare and of evidence-based medicine disease management. Methods: The research proceeds the secondary information analysis according to the National Health Insurance Research Database provided by National Health Research Institutes, analyzing healthcare quality with two hundred thousand people sampling from the enrollment files maintained by the Bureau of National Health Insurance based on the health insurance data from 2000 to 2004. The objects of study are the 510 hospitals appointed by the Bureau of National Health Insurance, which will be gathered statistics from and analyzed about quality indicators of hospital global budget healthcare and of evidence-based medicine disease management by the means of statistics such as Pair-t examination, regression, and so on. Results: After other variables are controlled, there is an obvious change of some items of quality indicators of healthcare after the execution of hospital global budget in this research, which includes utilization rate of injections in outpatient services and its revised version, utilization rate of antibiotics in outpatient services, repeated utilization rate of antacid from the same prescription in outpatient services (the revised version), rate of re-admission within 14 days after discharging from the same hospital (the revised version), rate of emergency treatment within 3 days after discharging from the hospital and its revised version, utilization rate of antibiotics for the infection of the upper respiratory tract, and utilization rate of Metformin for the diabetics with a complication of kidney disease ICD-9-CM 585. The quality indicators for the above mentioned items all descend obviously, which mark great significance in statistics. On the other hand, the items such as rate of prescribing chronic continuous prescriptions in outpatient services, rate of inappropriate days of medicine taking in the same hospital in outpatient services, rate of inappropriate days of medicine taking in outpatient services and its revised version, and rate of overlong hospitalization for more than 30 days have the quality indicators ascend obviously which mark great significance in statistics. In the comparison of the performance of 17 medical centers on the quality indicators of hospital global budget healthcare in outpatient and inpatient services and of evidence-based medicine disease management, 6 medical centers achieve more than 50% of the indicators in the part of hospital global budget healthcare quality in outpatient and inpatient services. However, two of the six hospitals doesn?t reach 50% or above in the part of quality indicator of evidence-based medicine disease management. Conclusion: The quality indicators of healthcare that have an obvious change after the execution of hospital global budget include utilization rate of injections in outpatient services and its revised version, utilization rate of antibiotics in outpatient services, repeated utilization rate of antacid from the same prescription in outpatient services (the revised version), rate of re-admission within 14 days after discharging from the same hospital (the revised version), rate of emergency treatment within 3 days after discharging from the hospital and its revised version, rate of prescribing chronic continuous prescriptions in outpatient services, rate of inappropriate days of medicine taking in the same hospital in outpatient services, rate of inappropriate days of medicine taking in outpatient services and its revised version, rate of overlong hospitalization for more than 30 days, utilization rate of antibiotics for the infection of the upper respiratory tract, and utilization rate of Metformin for the diabetics with a complication of kidney disease ICD-9-CM 585. Since the revised version of quality indicator of hospital global budget healthcare can be more significant as an indicator, we suggest using the revised version to monitor continuously and reinforcement the monitor of quality indicator of disease management toward hospitals in additionally