Department of Public Health, School of Health Sciences, University of Eastern Africa, Baraton, 30100 Eldoret, Kenya.
School of Health Care Administration, Taipei Medical University, Taipei 110, Taiwan.
Int J Environ Res Public Health. 2019 Feb 5;16(3):467. doi: 10.3390/ijerph16030467.
Studies on health care demand have indicated high levels of public satisfaction with Taiwan's National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers' way of practice, quality of care, utilization of care, and health expenditure. Studies focusing on the satisfaction of providers with health care supply, however, remain limited. We therefore explored the provider's perceived impact of the NHI allocation plan. A cross-sectional data of 299 health professionals was collected at Taipei Medical University Hospitals in April 2012. Perceptions and attitudes were assessed using a validated 5-point Likert-type questionnaire before using a structural equation modeling technique to explore the complex interrelationships of the NHI's perceived impact. The causal path relationships between the latent variables 'characteristics of NHI's allocation plan' and 'perceived positive effect' ( = 0.39), 'perceived positive effect' and 'satisfaction of health professionals' ( = 0.53), and between 'characteristics of NHI's allocation plan' and 'satisfaction of health professionals' ( = 0.30) were positively associated; while the path relationships between the latent variables 'perceived negative effect' and 'satisfaction of health professionals' ( = -0.27) and 'characteristics of NHI's allocation plan' and 'attitude toward allocation criteria' ( = -0.22) were negatively associated. These results indicate that providers perceived a positive impact of the NHI allocation strategy. The NHI allocation plan is an important decision-making tool among policy makers since it helps optimize outcomes. Research based on its impact at both horizontal and vertical levels on the supply side may be useful towards understanding Taiwan's GBAM. Policy-makers should therefore consider understanding the impact of GBAM at both the demand and supply side in adjusting allocation criteria.
医疗保健需求研究表明，公众对台湾全民健康保险（NHI）的满意度很高。然而，NHI 使用的全球预算分配机制（GBAM）导致提供者的实践方式、护理质量、护理利用和卫生支出发生了各种调整。然而，专注于提供者对医疗保健供应满意度的研究仍然有限。因此，我们探讨了提供者对 NHI 分配计划的感知影响。2012 年 4 月，在台北医学大学附属医院收集了 299 名卫生专业人员的横断面数据。使用经过验证的 5 点李克特量表评估感知和态度，然后使用结构方程模型技术探索 NHI 感知影响的复杂相互关系。潜在变量“NHI 分配计划的特征”和“感知积极影响”（=0.39）、“感知积极影响”和“卫生专业人员满意度”（=0.53）以及“NHI 分配计划的特征”和“卫生专业人员满意度”（=0.30）之间的因果路径关系呈正相关；而潜在变量“感知负面影响”和“卫生专业人员满意度”（= -0.27）以及“NHI 分配计划的特征”和“分配标准态度”（= -0.22）之间的路径关系呈负相关。这些结果表明，提供者感知到 NHI 分配策略的积极影响。NHI 分配计划是决策者的一个重要决策工具，因为它有助于优化结果。基于其对供应方横向和纵向层面的影响的研究可能有助于理解台湾的 GBAM。政策制定者应考虑在调整分配标准时，了解需求方和供应方的 GBAM 影响。
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