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Title: 以診斷關聯群為基礎的前瞻性支付制度是否有效?
Does Diagnosis Related Groups-based Prospective Reimbursement System Work?
Authors: 江家瑜
Contributors: 企業管理學系
Keywords: the Tw-DRG Reimbursement System;Hospital Performance;Hospital Profitability;Hospital Efficiency;Physician Fee Program;Pay-Performance Sensitivity
Date: 2013
Issue Date: 2014-10-01T08:51:30Z
Publisher: 國立台北大學
Abstract: The main purpose of the dissertation is to investigates whether the Taiwan Diagnosis Related Group-based prospective reimbursement system (Tw-DRG) works in Taiwan. This study consists of two independent chapters. Chapter 1 examines whether the Tw-DRG scheme improved hospital performance in a private not-for-profit hospital in Taiwan. This study compares data from the case hospital concerning monthly financial data and related information for 26 departments from 2009 (before the implementation of the system, i.e., the pre-Tw-DRG period) with that from 2010 following the implementation of the system (the Tw-DRG period). This study employs a pre- and post-design with a comparison group study approach. The intervention group consists of departments where more than one case is reimbursed under the Tw-DRG policy and are classified as the Tw-DRG group; and the comparison group consists of departments that do not have any cases reimbursed under the policy and are classified as the non-Tw-DRG group. Departmental operating profitability and efficiency in the case hospital are used to measure hospital performance over the two aforementioned periods. The results find that in contrast to the non-Tw-DRG group, the performance of the Tw-DRG group in the case hospital deteriorated after the introduction of the Tw-DRG program. This study aims to contribute to a better understanding of the economic roles of the Tw-DRG policy. Documenting the relationship between the regulatory intervention and hospital performance has policy implications for health policy officials and healthcare organizations. The findings of this study might also be valuable for health policy officials and healthcare organizations in other countries who are considering the implementation of prospective reimbursement systems.
In Chapter 2, this study examines the effects of a Physician fee (PF) program on a hospital’s performance before and after the implementation of the Tw-DRG scheme. I use a private not-for-profit hospital in Taiwan to investigate the research question. The data sample contains 624 monthly observations of the 26 departments in the case hospital for the period 2009-2010. Of the 26 departments, 18 have implemented the Tw-DRG reimbursement system and are classified as the Tw-DRG group; and the other 8 departments are classified as the non-Tw-DRG group. Since the introduction of the TW-DRG system, the physicians in both groups have been paid under the PF program. The pay-performance sensitivity measure is used to examine the relationship between hospital performance and physicians’ compensation before and after the implementation of the Tw-DRG system. The departments are classified according to their degree of Tw-DRG involvement, and the effects of the PF program on the hospital’s performance are assessed. Overall, the results show that the case hospital’s performance deteriorated after the implementation of the Tw-DRG system. The results imply that conflicts arise between departments that are under the Tw-DRG reimbursement scheme and those that have implemented the PF program. This study also provides evidence that physicians’ behavior affects their clinical performance, especially under a strict cost containment payment policy. Hence, health service researchers and healthcare providers should reexamine incentive mechanisms for physicians that work under similar payment policies.
Relation: 博士; 國立台北大學會計學系
Appears in Collections:[企業管理學系] 專書

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