To compare the differences of healthcare utilization before and after hospital global budget payment system for patients seeking for the same healthcare organization

[[abstract]]In July 2002, Bureau of National Health Insurance (BNHI) implemented hospital global budget payment system, and successively pursued the self-management and excellent project for hospitals like hospital-based global budget. It was worth to study if the implementation of these policies would make the patients who used to visit hospitals visit the clinics or not. Most studies about hospital global budget payment system were overall analysis or took the hospital as a unit of study to analysis, and it was rarely just to treat a chort to compare the differences of healthcare utilization before and after the implementation of hospital global budget payment system. Therefore, this study will focus on the patients who always sought for the hospitals before hospital global budget payment system, and to compare the differences of the patients seeking for the level of medical institutes and healthcare utilization of the patients before and after hospital global budget payment system. This study applied secondary data analysis to representative NHI enrollees sample files between 1999 and 2004 provided by the National Research Institute. The sample were the patients who only visited the hospital during the two years before the implementation of hospital global budget payment system (not included the dental services and Chinese medicine services). It contained 4043 subjects in this study. The period of observation was from July 2000 to June 2004, and it was divided into 8 terms by 6 months. These results show that the proportion of the patients who sought for the clinics and the healthcare utilization in clinics increased after hospital global budget payment system. About healthcare utilization of inpatients, the healthcare utilization of inpatients didn?t change too much before hospital global budget payment system, but after hospital global budget payment system the rate of growth in healthcare utilization of inpatients increased rapidly. About healthcare utilization of outpatients in hospitals, except the trend of the number of ambulatory visits in hospitals, the trend of the claimed points of outpatients, the days of prescriptions, the claimed points of drugs of outpatients were increased. The number of ambulatory visits in hospitals decreased after Hospital Global Budget Payment System, but the number of ambulatory visits (included the number of ambulatory visits in clinic) increased. In conclusion, the patients who always sought for the hospitals before hospital global budget payment system had the tendency to go to the clinics after hospital global budget payment system, but we had to attend that if there were serious ill patients who were rejected from hospitals going to the clinics. The hospitals increased the medical services of inpatients, and it might due to the distribution of rate of the budget for outpatient services and inpatient services. The number of ambulatory visits of outpatients in hospitals decreased and the claimed points of outpatients in hospitals increased shows that the hospitals supplied more density of medical services for the patients or just claimed more points of medical services. In sum, the healthcare utilization of both outpatients and inpatients increased, and the rate of growth of total claimed points after hospital global budget payment system was more than before. It shows that the healthcare utilization of patients was still increasing, and it was worth for the government and the medical service providers to pay attention to this situation