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台湾全民健保制度下总额预算对医疗效率之影响。

The Impact of Global Budgeting on the Efficiency of Healthcare under a Single-Payer System in Taiwan.

机构信息

Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan.

Department of Industrial and Information Management, National Cheng Kung University, Tainan City 701, Taiwan.

出版信息

Int J Environ Res Public Health. 2021 Oct 19;18(20):10983. doi: 10.3390/ijerph182010983.


DOI:10.3390/ijerph182010983
PMID:34682728
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8535506/
Abstract

Since 1995, a national health insurance (NHI) program has been in operation in Taiwan, which provides uniform comprehensive coverage. Forced by severe financial deficit, global budgeting reimbursement was adopted in the healthcare sector to control healthcare expenditures in 2002. A two-stage data envelopment analysis (DEA) approach was used to measure the efficiency of hospital resource allocation among stakeholders in Taiwan's NHI system, and to further explore the changes in resource allocation after the introduction of a global budgeting payment scheme. The dataset was collected from the annual statistical reports of Taiwan's Ministry of Health and Welfare (MOHW) and was used to estimate the efficiency of resource allocation in hospital-based healthcare services under global budgeting. In terms of efficiency during the period from 2003 to 2009, one-third of decision-making units (DMUs) improved their productivity in stage I, and seven out of the total of eighteen DMUs saw falls in financial efficiency in stage II. After global budgeting was implemented, there were significant positive impacts on the efficiency of hospital resource allocation in Taiwan. The two-stage DEA model for analyzing the effects of the global budgeting reimbursement system on productivity and financial efficiency represents a key decision-making tool for hospital administrators and policymakers.

摘要

自 1995 年以来,台湾一直实行全民健康保险(NHI)计划,提供统一的综合保障。由于严重的财政赤字,2002 年医疗保健部门采用了全球预算报销制来控制医疗支出。本研究采用两阶段数据包络分析(DEA)方法,衡量了台湾全民健康保险系统中利益相关者的医院资源分配效率,并进一步探讨了引入全球预算支付方案后资源分配的变化。数据集来自台湾卫生福利部(MOHW)的年度统计报告,用于估计全球预算下基于医院的医疗服务的资源配置效率。在 2003 年至 2009 年期间的效率方面,三分之一的决策单元(DMU)在第一阶段提高了生产力,18 个 DMU 中有 7 个在第二阶段的财务效率下降。实施全球预算后,对台湾医院资源配置效率产生了显著的积极影响。用于分析全球预算报销系统对生产力和财务效率影响的两阶段 DEA 模型是医院管理者和政策制定者的重要决策工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/5aa7d1a0331f/ijerph-18-10983-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/9b0ace3468c8/ijerph-18-10983-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/d82cd8dfc687/ijerph-18-10983-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/d199f26db73e/ijerph-18-10983-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/5aa7d1a0331f/ijerph-18-10983-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/9b0ace3468c8/ijerph-18-10983-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/d82cd8dfc687/ijerph-18-10983-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/d199f26db73e/ijerph-18-10983-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f26d/8535506/5aa7d1a0331f/ijerph-18-10983-g004.jpg

相似文献

[1]
The Impact of Global Budgeting on the Efficiency of Healthcare under a Single-Payer System in Taiwan.

Int J Environ Res Public Health. 2021-10-19

[2]
Efficiency of resource allocation in the hospital sector after global budgeting under National Health Insurance.

Chin Med J (Engl). 2013

[3]
Managing health expenditure inflation under a single-payer system: Taiwan's National Health Insurance.

Soc Sci Med. 2017-11-16

[4]
Measuring health care efficiency with a tripartite configuration under the "National" Health Insurance system.

Chin Med J (Engl). 2014

[5]
Provider Behavior Under Global Budgeting and Policy Responses: An Observational Study on Eye Care Services in Taiwan.

Inquiry. 2015-8-30

[6]
Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

Value Health Reg Issues. 2018-5

[7]
The impact of global budget on the diffusion of innovations: the example of positron emission tomography in Taiwan.

BMC Health Serv Res. 2018-11-29

[8]
Reflections on the 20th anniversary of Taiwan's single-payer National Health Insurance System.

Health Aff (Millwood). 2015-3

[9]
Use of selected ambulatory dental services in Taiwan before and after global budgeting: a longitudinal study to identify trends in hospital and clinic-based services.

BMC Health Serv Res. 2012-9-25

[10]
Does a global budget superimposed on fee-for-service payments mitigate hospitals' medical claims in Taiwan?

Int J Health Care Finance Econ. 2014-12

引用本文的文献

[1]
The effect of hospital budgeting system on physician-executives' budget cognitive consciousness and medical decision making.

Cost Eff Resour Alloc. 2025-5-21

[2]
The prospects and limitations of liquid biopsy utilization for clinical practice in Taiwan.

J Liq Biopsy. 2025-3-6

[3]
The efficiency evaluation of traditional Chinese medicine hospitals by data envelopment analysis in Zhengzhou, China.

Front Public Health. 2024

[4]
Evaluation of healthcare-related factors influencing mental health of Taiwanese citizens among different age groups.

Sci Rep. 2024-3-26

[5]
The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals.

Healthcare (Basel). 2022-7-15

本文引用的文献

[1]
Technical Efficiency of Regional Public Hospitals in China Based on the Three-Stage DEA.

Int J Environ Res Public Health. 2020-12-15

[2]
A four-stage DEA-based efficiency evaluation of public hospitals in China after the implementation of new medical reforms.

PLoS One. 2018-10-3

[3]
Hospital response to a global budget program under universal health insurance in Taiwan.

Health Policy. 2009-4-9

[4]
A 12-year analysis of Malmquist total factor productivity in dialysis facilities.

J Med Syst. 2006-10

[5]
A comparison of single- and multi-payer health insurance systems and options for reform.

Health Policy. 2003-12

[6]
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N Engl J Med. 2003-8-21

[7]
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[8]
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Rand J Econ. 2001

[9]
Preconditions for health reform: experiences from the OECD countries.

Health Policy. 1995

[10]
Global budgeting in the OECD countries.

Health Care Financ Rev. 1993

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