Ying Yung-Hsiang, Cheng Han-Chih, Chen Mei-Jung, Lee Wen-Li, Chang Koyin
College of Management, National Taiwan Normal University, Taipei 106, Taiwan.
Department of Ophthalmology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan.
Healthcare (Basel). 2025 Mar 7;13(6):587. doi: 10.3390/healthcare13060587.
Existing research highlights the necessity of tailoring cost-containment policies to specific treatments due to the varying benefits across different diseases. This study contributes additional insights by examining the impact of such policies on a non-acute condition-cataracts. Leveraging 16 years of national health insurance claim data, this research assesses the influence of three prevalent cost-containment payment schemes on healthcare service utilization. Outcome variables for analysis include the decision to adopt intraocular lens (IOL) insertion, outpatient visit volume, and healthcare expenditures. The robustness of the findings is enhanced through the use of statistical methods, such as logit, Poisson, negative binomial, and panel fixed-effect models. Global budgeting reduces the likelihood of procedure adoption and negatively impacts the volume of outpatient consultation services. Cost sharing does not affect procedure adoption but significantly impacts outpatient service volume. The prospective payment scheme for cataract IOL treatment shows no long-term effects on service utilization, with treatment rates stabilizing after a few years of policy implementation. Despite reimbursement points remaining unchanged for over two decades, there is no evidence of the under-provision of treatment. This study underscores the significant responsiveness of both patients and providers to policy reforms in the non-acute disease category. Manipulating payment schemes can lead to cost savings, particularly when treatment plans and procedures exhibit increased elasticity in their provision.
现有研究强调，由于不同疾病的益处各不相同，因此需要针对特定治疗制定成本控制政策。本研究通过考察此类政策对非急性疾病——白内障的影响，提供了更多见解。本研究利用16年的国家医疗保险索赔数据，评估了三种普遍的成本控制支付方案对医疗服务利用的影响。分析的结果变量包括是否采用人工晶状体植入术的决策、门诊就诊量和医疗支出。通过使用逻辑回归、泊松回归、负二项回归和面板固定效应模型等统计方法，增强了研究结果的稳健性。总额预算减少了采用手术的可能性，并对门诊咨询服务量产生负面影响。费用分担不影响手术采用，但对门诊服务量有显著影响。白内障人工晶状体治疗的前瞻性支付方案对服务利用没有长期影响，在政策实施几年后治疗率趋于稳定。尽管报销点数在二十多年里一直保持不变，但没有证据表明治疗供应不足。本研究强调了患者和提供者对非急性疾病类政策改革的显著反应。操纵支付方案可以节省成本，特别是当治疗计划和程序在提供方面表现出更大弹性时。
