ABSTRACT
From August 1, 1999, ¡§Co-payment For the Frequent-Visit Outpatients¡¨ has gone into effect. Frequent visit outpatients have to pay more medical expenses out of their own pocket. How did the new co-payment scheme affect the medical expenditure and utilization of the outpatients, especially frequent-visit outpatients? Can this new co-payment scheme work efficiently and reach its goal: reduce the unnecessary waste of the medical resources?
At Taiwan, Central Healthcare and Medical Service (CHMS) has a large outpatient database, which contains the basic information of the outpatients. This study chose the database about the ¡§Frequent Outpatients¡¨ from August-December 1998, and August-December, 1999 as population. Such data included the 157,613 cases from 1998 and 160,870 cases from 1999.
By analyzing the 1998 and 1999 data provided by the Central Healthcare and Medical Service, this study found the followings have been changed since new scheme took effect:
1. Co-payment had broad and deep effect on the patients¡¦ medical care utilization. Due to the additional High Medical Utilization Co-payment Fee, NT 50 or NT 100, outpatients would be more cautious before they go to see the doctors. At the same time, trying to get more for what they pay, outpatients would rather go to the major regional hospitals or centers in the medical system than small hospitals or clinics. As for the prescribed drug, outpatients were inclined to ask doctors for prescription drugs that can be taken for more days, so they can reduce their visits and therefore save some co-payment fees. This study also found prescribed drug expenses per patient dramatically increase when the average drug expenses per day decrease. Apparently, the increased drug expenses were form the more prescribed-drug days per visit. With the drug expenditures going up, average outpatient expenses per visit increased and the detailed and combination of medical bill varies.
2. Male and female had different responses to this new co-payment scheme. The gender-oriental differences were found in the following areas:
¡]1¡^Regional hospitals (centers) or small clinics. ¡]2¡^The average prescribed-drug days for each visit. ¡]3¡^Drug expenditure per day per patient.¡]4¡^Total expenses per outpatient visit. ¡]5¡^The detailed breakdown of each outpatient visit¡¦s expenses.
3. No effect on the following outpatient age segments:¡¨ age 6-14 teenager¡¨,¡¨ age 15-24 young people¡¨, and ¡§age 25-44 adults¡¨. The new co-payment system had no effect on the above-mentioned age groups, but it did have big and deep influence on the ¡§age 45-64 mid-age adult¡¨ and ¡§age 65 + elderly¡¨, especially on the elderly. The elderly were the major medical service user, and a lot of them lived on their retire and lived on their pensions, so they got hit badly by the high co-payment.
4. In general the higher co-payment had big effect on following three groups:
¡]1¡^¡§Media-utilization Outpatient Group¡¨, ¡]2¡^¡§High- utilization Outpatient Group¡¨ ¡]3¡^¡§Extremely- utilization Outpatient Group¡¨
To save money, outpatients, whatever group they belong to, would reduce their doctor visit.
After analyzing all of the above-mentioned aspects, impacts, differences, changes and effects this high co-payment have had on the different age and gender groups since August 1999, this study concluded that the new co-payment regulation had significantly reduced the medical service demands, especially from female or male age 45+.
| Identifer | oai:union.ndltd.org:NSYSU/oai:NSYSU:etd-0828101-110035 |
| Date | 28 August 2001 |
| Creators | Lo, Ying-Ying |
| Contributors | Shu-Chuan Jennifer Yeh, Chin-Ming Ho, Herng-Chia Chiu |
| Publisher | NSYSU |
| Source Sets | NSYSU Electronic Thesis and Dissertation Archive |
| Language | Cholon |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.lib.nsysu.edu.tw/ETD-db/ETD-search/view_etd?URN=etd-0828101-110035 |
| Rights | withheld, Copyright information available at source archive |
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