Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Shu-Chow Rd., Rm. 639, Taipei, Taiwan.
Soc Sci Med. 2011 Jul;73(1):153-9. doi: 10.1016/j.socscimed.2011.05.007. Epub 2011 May 27.
Controlling the cost of chronic diseases remains one of the vexing problems of developed and developing nations alike. Taiwan, faced with rapidly escalating healthcare costs associated with End Stage Renal Disease (ESRD) services utilization, imposed an outpatient dialysis global budget (ODBG) on outpatient dialysis care. This study, using a before and after study design with a comparison group, assessed the impact of this policy innovation on outpatient, inpatient and emergency room utilization. Using a difference in difference (DID) strategy and the generalized estimating equation (GEE) approach, this study found providers responded to these changes through cost reduction and revenue enhancement strategies. This study extends our understanding of provider responses to changes in reimbursement policies that target one segment of the continuum of care required by chronic disease patients.
控制慢性病的成本仍然是发达国家和发展中国家共同面临的难题之一。台湾面临着与终末期肾病（ESRD）服务利用相关的医疗保健成本迅速上升的问题，对门诊透析实施了门诊透析全球预算（ODBG）。本研究采用前后对照研究设计和对照组，评估了这一政策创新对门诊、住院和急诊室利用的影响。本研究采用差异（DID）策略和广义估计方程（GEE）方法，发现提供者通过成本降低和收入增加策略来应对这些变化。本研究扩展了我们对提供者对针对慢性病患者所需护理连续体的一个部分的报销政策变化的反应的理解。
