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Student Number 93441005
Author Li Chuang(±i¤O)
Author's Email Address No Public.
Statistics This thesis had been viewed 1749 times. Download 717 times.
Department Business Administration
Year 2007
Semester 1
Degree Ph.D.
Type of Document Doctoral Dissertation
Language English
Title THE EFFECT OF COST CONTAINMENT AND QUALITY AFTER THE NATIONAL HEALTH INSURANCE SYSTEM IN TAIWAN
Date of Defense 2007-11-13
Page Count 63
Keyword
  • Cost containment
  • Quality of healthcare services
  • Hospital costs
  • National Health Insurance
    • Abstract Taiwan implemented the National Health Insurance system (NHI) in 1995. However, after the NHI, the insurance coverage expanded and competition increased, whether the cost containment and quality are improved. The main purpose of this study was to examine the dynamic change in cost containment and quality under the National Health Insurance (NHI) program in Taiwan. Moreover, the objective of this study is to determine what factors have direct impact on the increased costs after the NHI.
    Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The findings show that the current monitoring system does not help to improve cost containment after the implementation of the NHI. Indeed, the fee-for-service system of the NHI has led to healthcare resource waste ¡V poor cost containment. Additionally, the increasingly competitive market (increased number of contractual hospitals and freedom to choose hospitals policy) has led to a better healthcare quality. This implies that healthcare policies can only improve either quality or cost separately; the monitoring system of BNHI only could improve quality, but not cost containment. Furthermore, the results indicate that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. 
    Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. Additionally, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro aspect) and to control healthcare expenditures (macro level).
    Table of Content CHAPTER 1  INTRODUCTION              1
    1.1. MOTIVATION AND RESEARCH PURPOSE       1
    1.2. RESULT PREVIEW                 4
    1.3. THESIS STRUCTURE                6
    CHAPTER 2  BACKGROUND              8
    2.1. THE NHI SYSTEM (THE SINGLE-PAYER SYSTEM) IN  
    DEVELOPED COUNTRIES             8
    2.1.1. The National Health Service system in the U.K.       8
    2.1.2. The National Health Service system in Canada     10
    2.2. The NHI system in Taiwan             12
    2.2.1. Before the reform                  12
    2.2.2. After the reform                  13
    CHAPTER 3  THEORETICAL FRAMEWORK LITERATURE
    REVIEW AND HYPOTHESE        17
    3.1 COST AND QUALITY               17
    3.1.1 Patients as principals and physicians (hospitals) as agents 17
    3.1.2. Owners as principals and the employees (physicians) in  
    hospitals as agents                  19
    3.2. COST DRIVERS                 20
    3.2.1 Aging population                   21
    3.2.2 Types of diseases                   22
    3.2.3 New medical technology                23
    3.2.4 Length of stay                    24
    3.2.5 Household income                  24
    3.2.6 Family size                     25
    3.2.7 Financial structure                  25
    3.2.8 Subsidies                      26
    CHAPTER 4  SAMPLE AND METHOD         27
    4.1. METHOD                    27
    4.2. STUDY MODEL                 27
    4.3. DATA                      31
    CHAPTER 5 EMPIRICAL RESULTS           32
    5.1. UNIVARIATE ANALYSIS             32
    5.1.1 Comparison before and after the NHI          32
    5.1.2 Trend analysis ¡V cost and quality            33
    5.1.3 Cost and quality before and after the NHI        33
    5.2. PANEL DATA REGRESSION ANALYSIS      38
    5.2.1 Cost and quality                   38
    5.2.2 Cost drivers                     38
    5.3. ROBUSTNESS TESTS               43
    5.3.1 Cost drivers                     43
    CHAPTER 6 DISCUSSION AND CONCLUSION      46
    6.1. WHETHER THE NHI HAS ACHIEVED BETTER   
    COST CONTAINMENT AND QUALITY OF CARE  46
    6.2. WHETHER THE INCREASE OF HEALTHCARE    
    COSTS ARE REASONABLE            47
    6.3. WHAT DRIVERS INFLUENCE ESCALATED     
    COSTS AFTER THE NHI             51
    6.4. IMPLICATIONS                  54
    6.5. CONTRIBUTION                 55
    6.6. LIMITATION AND FUTURE RESEARCH      55
    REFERENCES                      56
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    Date of Submission 2007-11-23

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