none

The purpose of this research aims to (1) construct the predict model by system dynamics on the outpatient visits; (2) investigate the influence on hospital performance after drug price policies made; and (3) offer feasible schemes by scenario simulation. National Health Insurance (NHI) system intends to safeguard the right to health care for all residents in Taiwan. NHI system has gained high public satisfaction so far. However, medical expenditures and pharmaceutical costs have propelled the rapid growth in recent years because of the stipulation of the insurance premium rate, the general push for improved health care quality, and inclusion of new drugs as well as new technologies. To prevent the deficit of the NHI system¡¦s finances from widening further, the Bureau of NHI is urged to reform the reimbursement policies, including Adjustments of Drug List and Payment Scheme, Global Budget Payment System, and Adjust Reasonably Reimbursement Criteria as well. Based on the statistics, a quarter of the total revenues were for the drug cost. Legally mandated drug price adjustments have a great influence on the financial burden of the medical institutions. On the basis of the simulation analysis, the major findings of this research are summarized as follows: (1) The adjustments of the prescription depend on the amount of the profit gained from the drugs; (2) The increase the refillable prescriptions for patients with chronic illnesses enhances the profit of the drugs; (3) With the implementation of the system dynamics, the counterintuitive phenomenon can be identified and used to guide the future policies of the medical institutions. This research also suggests that the total comprehension of finding the leader loop in the dynamic complexity system within the management of the medical institutions is beneficial in providing the relative adjustment policies for a hospital.

Abstract After the National Health Insurance was implemented ,it provides our citizens not only the basic medical treatment but also reduce the financial burden. However, the financial difficulties is becoming worse for National Health Insurance of Taiwan. In order to reduce the medical expenses. The Health Insurance authorities implemented many different policies.Balance billing was one of these interventions. The purposes of this research included to understand the relationships between the balance billing and the characteristics of physicians and patients .Particularly, this research focused on the perceptions of balance billing form the Physicians and hospitalized patients¡¦points of view. The Andersen¡¦s health behavior model was the conceptual framework for this study. The questionnaire was sent out to 200 doctors and 1000 patients in Kaohsiung , Pingtung regional hospitals ,with 101 (response rate 50.6%) and 638 (63.8%)returned , respectively. The characteristic and the attitude towards balance billing system such as medical quality, medical care and medical expenses from both physicians and patients were collected. Descriptive analysis and logistic regression were used to analyze this study. The Results from physicians survey are summarized as follows: 1.There were no statistical significance between the physicians¡¦ characteristics (such as age, gender, and tenure) and the agreement of balance billing .Ninety-four out of 101 physicians agreed on the new policy. 2.There would be no influence of balance billingon the medical care from the perspective of physicians. 3.Physicians who agreed on the viewpoints of paying extra payments would lead to the better treatment were 12 times more likely to accept the balance billing. 4.There were no difference among medical expenditures, the level of understanding, and the policy of balance billing. The results from inpatient survey are summarized as follows: 1. Inpatients demographic characteristics, (such as education¡Boccupation and disease), were significant related to the agreement of the policy of balance billing system. However, there were no statistical difference in age, gender, language, and private insurance. 2.Most inpatients who agreed on the balance billing policy were 1.8 times more to believe that if they paid out-of-pocket, they would gain more medical attention form physicians. 3.Regarding the quality of care, inpatients whoever agreed upon the policy of balance billing would perceive that they would receive 3 to 3.8 times higher quality of care in medical materials and medicine, respectively. 4.The more the agreement of the balance billing policy, the higher the satisfactory. 5.Inpatients who understood the new policy were more likely to pay extra payment. Based on the results from this study, it is certain to conclude that both the doctors and inpatient of the region hospital are supporting the balance billing policy .The average score of the inpatient questionnaire is 3.305.And 93.1% of the surveyed. Doctors accepted the policy of balance billing. We encouraged the bureau of National Health Insurance to continuing communication with the public and the providers to assure the success of new policy.

The National Health Insurance (NHI) in Taiwan has implemented over ten years. It¡¦s always attention-getting when the govermnet changes some policy or insurance premium of NHI. This time, our government wants to make a bigger reform of NHI called ¡§second generation NHI¡¨ and it will make a bigger storm of our social. So this research compares the NHI with ¡§second generation NHI¡¨ not only to let us know what NHI in Taiwan is but also to give the government the references of NHI. This research will discuss insurance organization, insured object, insurance agent, insurance recompense, insurance Healing institute and insurance finance between NHI and ¡§second generation NHI¡¨ and it will point out what are good and bad of two NHIs to help the government to correct NHI. Finally, I find five problems of our NHI¡¦s development in the result of my research; they are problems of insurance finance, NHI Payment, waste of NHI expense, quality of cure and executive extent of NHI. Also, I suggest several parts of NHI: first, advance the health protection; second, manage the medicine strictly; third, improve the use of NHI IC card; fourth, public NHI¡¦s financial affairs; fifth, make a new NHI payment; sixth, assist the Healing institutes; seventh, establish the bureau of national social insurance and eighth, adhere to the original plan of NHI.

Thesis (Ph.D.)--University of California, Davis, 2008. / Adviser: J. Edward Taylor. Includes bibliographical references.

Thesis (Ph.D.)--Ohio University, August, 2009. / Title from PDF t.p. Includes bibliographical references.

Universiẗat, Diss., 2006--Berlin.

The National Health Insurance (NHI) program was officially launched in Taiwan on 1 March 1995. Three objectives are stressed in the program¡¦s implementation: (1) universal enrollment and equal-opportunity medical care; (2) balanced finances and long-term operational viability; (3) better quality medical care and better health for citizens. The initial balance of revenues and expenditures was stable, but there is a deficit during 1998. In order to prevent the financial status from keeping on worsening, the Bureau of NHI (BNHI) implement the global payment system, and expand the payroll-related premium base. What are the long-tem influences of these policies on the financial status and medical quality? Up to now, those researches of handling the financial problem of the NHI, focused mostly on those influences of the individual policies, rare studied the long-term whole influences of multiple policies. Moreover, those methods of the researches were mostly questionnaires, data analysis, regression, rare simulated methods. Hence, this dissertation applies system dynamics to explore the long-term influences of multiple policies on handling the financial problem of the NHI. There are two purposes in the research. One is that using those interacted relationships of decisions taken by the BNHI, beneficiaries, and contracted medical care institutions to understand those causes of the financial problem of the NHI, the other is that evaluating the long-term influences of multiple policies on handling the financial problem of the NHI. This research reaches two achievements. First, submitting casual loop diagrams focused on the financial problem of the NHI, can provide the BNHI, beneficiaries, and CMCI to have a further understanding on the financial problem of the NHI. Second, building the model of the financial problem and policies of the BNHI can simulate and evaluate he results of multiple policies on handling the financial problem of the NHI. In order to improve the financial imbalance of the NHI, the BNHI proposes three policies. Policy I, implement the global payment system. Policy II, implement the global payment system and expand the payroll-related premium base. Policy III, implement the global payment system, expand the payroll-related premium base and promote health communication. The simulation results are as follows: Policy III can solve the financial imbalance of the NHI and improve the health of citizens. This research has two reservations. First, only explore the financial status and medical quality. Second, different criteria using for judging the priority of policies under multilple objectives may have different results. Hence, the future research can deeply consider extending the model boundary and selecting the criteria using for judging the priority of policies under multilple objectives.

Abstract Due to the rapid rise in medical expenses and unanticipated accumulation of overdue premiums, Taiwan's National Health Insurance has impacted the management of all-size hospitals. For the purpose of survival and maintaining good performance, the hospitals need to adopt suitable strategic management. Medical centers take the responsibilities of service, teaching, and research, it should be some hard thinking as to how to manage the hospital continuously and make every effort to achieve the goal of ¡§health for all in the twenty-first century¡¨. This study was conducted in three stages: questionnaire development and testing, surveying, and data analysis. The 34-item questionnaire was self-made according to the definition and contents of community health nursing defined in United Kingdom Central Council (UKCC). Seven hundred and forty questionnaires were send to the community inhabitants with 679 were returned and valid, representing a response rate of 91.8%. Descriptive analysis, Chi-Square test, Pearson correlation analysis, factor analysis, and stepwise regression analysis were used for the statistical analysis. The information about community health nursing was obtained from bureau of public health in the majority of inhabitants (57%). As for the satisfaction of service of community health nursing to the inhabitants, people who were satisfied is less than those who weren't (21.4% vs 41.2%). Though fewer inhabitants who had a favorable impression on the medical center, more people prefer medical center to practice community health nursing. Community health nursing was classified into seven dimensions according to the factor analysis, "home health care" had a highest score (4.23), and "mental health care" got a lowest score (3.64). There was significant negative correlation between satisfaction and "supporting school health nursing", "home health care is of more humane care", "hospital gains profit from home health care", "willing to take home health care", and "hospital cooperates with community to care mental disabled". Significant positive correlation was noted between satisfaction and "accepting mental disabled in the community". In age 30-39 and 40-49, relating to the satisfaction of community health nursing, inhabitants who were unsatisfied are more than those who weren't, significant difference was noted. People who had higher educational background felt unsatisfied to the service of community health nursing, and the higher the less. Through stepwise regression analysis, "establish referral system" had the best predictability in using facilities efficiently to economies of scale to reduce operating cost; "ability to provide better service" had the best predictability in confidence of practicing community health nursing in medical center; "medical center is a good neighbor" had the best predictability in increasing benefits from practicing community health nursing; and "public health nursing helping disease prevention" had the best predictability in government health policy.

Thesis (Ph. D.)--University of Sydney, 2005. / Title from title screen (viewed 20 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Sociology and Social Policy, Faculty of Arts. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.