The Impacts of Outpatient Volume Control on the Medical Quality of Inpatient Department and Emergency?Case of a Public Medical Center

[[abstract]]The growth of medical expenditure is higher than that of premium revenues since 1998. To curb the escalating medical expenditure, Bureau of National Health Insurance began to implement phased-in Global Budget Payment Scheme by medical category at that time. Furthermore, a ?Hospital Self-Management? and ?Center for Excellence Plan? were respectively introduced on 2003 and 2004 to assure medical quality and control costs. Consequently, many hospitals responded to take actions, such as controlling the outpatient volume, closing the night clinics, and postponing the non-emergency surgeries, which may lead to jeopardize people?s access to health care. The potential impacts on medical quality might emerge. Therefore, this dissertation aims at: (1) Observing the volume changes in inpatient and emergency rooms after limiting the outpatient volumes of a case hospital; (2) Comparing the changes in emergency department triage and inpatient Case-Mix Index (CMI) before and after launching the outpatient volume control policy; (3) Analyzing the impacts of outpatient volume control policy on medical quality. Hopefully, our findings regarding the quality impacts of hospital?s behavior could be reference for peoples who seek health care, for hospital administrators who make the decision, and for the health authority who monitor the health services. A public medical center was called for as a research source for our study. In addition, we collected July to December data of Year 2002, 2003, and 2004 retrospectively to analyze the impacts of outpatient volume control policy on the volume changes in inpatient and emergency department as well as medical quality indicators, including returning to the emergency department within 24 hours, returning to the emergency department within 72 hours, retaining in the emergency department over 72 hours, readmission rate within 14 days, and average length of stays. Inferential statistics, such as F-test and Independent t-test, were employed in the study. The study observed increasing service volume of the emergency department, and increasing the second class of emergency department triage right after the outpatient volume control policy put into action. But there was no evidence to verify the substitute effect between the services volume of outpatient and emergency department visits. For the impacts on medical quality of the emergency department, we found an increasing volume of retaining in the emergency department over 72 hours, an increasing number of transferring to other hospitals, and increasing volume of returning to the emergency department within 72 hours. For the impacts on medical quality of the inpatient department, there is a significant increase in the average length of stays as well as readmission rate within 14 days. However, after deducting the number of patients who returned back to the hospital for one-day chemotherapy or radiotherapy, there was no difference in terms of readmission rate within 14 days among Year 2001, 2002, and Year 2003. The suggestions are shown as follows. (1) To maintain good quality, the emergency increase manpower dispatch shall keep maneuverable to avoid potential overburden. (2) The outpatient volume control policy of the study case, though reduced the access of people?s medical seeking, didn?t sacrifice the medical quality. From the viewpoint of original purpose in implementing ?Center for Excellence Plan? monitored by the Bureau of national Health Insurance, it seemed that the case hospital still met the eligibility and fulfilled its requirements. (3) The outpatient volume control policy is merely a short term contingent strategy, comprehensive referral system and family physician design will be the remedy to distribute the medical resources efficiently in the long run