Effectiveness of coping strategies used by hospitals in response to implementation of a case-based payment system by the National Health Insurance program.

BACKGROUND AND PURPOSE

The introduction of the case-based payment system by the Bureau of National Health Insurance resulted in greatly increased pressure on the health care industry in Taiwan. This study examined the relationship between the coping strategies adopted and the results attained by accredited teaching hospitals and non-teaching regional hospitals when responding to this regulatory change.

METHODS

A cross-sectional survey was conducted using a structured questionnaire to assess the hospitals' characteristics, and coping strategies at the technical, managerial and institutional levels in response to the case-based payment system, and to compare these strategies with self-evaluation of the effectiveness of these strategies. The questionnaire was sent in early October 2000 to the superintendents of the 129 hospitals that were accredited at the medical center, regional hospital, and district teaching hospital levels in the year 2000. Factor analysis was applied to group the strategies into categories and stepwise regression analysis was used to explore the relationship between the reported coping strategies adopted and their effectiveness as evaluated by participants.

RESULTS

Among the selected hospitals, 89 responded with complete data, a 69% response rate. The following 7 factors were extracted from 30 coping strategies: information and financial analysis; service shifting and unbundling; service integration and quality improvement; service specialization and strengthening; education and training; financial incentives; and claim submission skill. After adjusting for accreditation level or ownership status, 2 main findings were noted. First, hospitals that implemented financial incentives strategies such as holding physicians responsible for all or part of the shortfall between actual claim submissions and actual reimbursements, and reducing or withholding payment to physicians beyond the standard length of stay, tended to increase medical revenue (odds ratio, 1.21). Second, hospitals that implemented service integration and quality improvement strategies, such as implementing a discharge plan, implementing clinical pathways and periodic review of quality indicators, attained higher patient satisfaction rate (odds ratio, 1.40).

CONCLUSIONS

This study suggests that hospitals confronting the implementation of a case based-payment system may benefit by adopting financial incentives strategies and by efforts to improve service integration and quality.