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Efficiency of resource allocation in the hospital sector after global budgeting under national health insurance

Chinese Medical Journal 2013年第15期126卷 2900-2906页

作者： Victor Kreng YANG Shao-wei Department of Industrial and Information Management Cheng Kung University Tainan Taiwan China

Background Taiwan has implemented a national health insurance （NHI） program to provide uniform comprehensive coverage since 1995. Forced by the severe financial deficit, global budgeting is introduced to replace the original payment system in Taiwan＇s NHI. Under global budgeting system, the total budget is distributed to six geographical regions in Taiwan. There is no pre-determined budget for each hospital. In order to investigate the longitudinal trend of how global budgeting influences health care resource, it is essential to estimate the efficiency of resource allocation in Taiwan＇s NHI. Methods Data Envelopment Analysis （DEA） and Malmquist index （MI） are used to investigate the 8-year panel data of 23 cities and counties which was collected from the annual report from the Department of health, Taiwan, China. A value of MI greater than 1 indicates that total factor productivity progress has occurred, while a value of MI less than 1 indicates productivity loss. Results As a result, 37 of the 184 DMUs in the analysis were found to be relatively efficient during the period, in which 14 of 23 DMUs are efficient in 2002 right after adopting globe budgeting. A trend of MI declines between 2002 and 2009 implies the volume of health care services decrease after adopting global budgeting system. Production efficiency has been improved after global budgeting implies that behaviors of health providers control cost and avoid wasting resource at macro level. Conclusions The regressive MI indicates the hospitals redistribute health care resource to eliminate unnecessary treatment and to control the growth of service volume under global budgeting system. Hence, a trend of declining MI focuses on health care resource redistribution rather than efficiency improvement in this study.

关键词： national health insurance global budgeting data envelopment analysis Malmquist index resource allocation efficiency

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Measuring health care efficiency with a tripartite configuration under the ＂national＂ health insurance system

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Chinese Medical Journal 2014年第9期127卷 1633-1639页

作者： Victor B. Kreng Yang Shao-wei Lin Chien-Hsu Department of Industrial and Information Management Cheng Kung University Tainan Taiwan China

Background The ＂national＂ health insurance （NHI） in Taiwan, China is a single-payer system that was introduced in 1995 to provide universal health care. It is worth noting that three stakeholders are involved in Taiwan＇s NHI, which can be seen as a triangular governance regime between the Bureau of ＂national＂ health insurance （BNHI）, the insured and providers. Accordingly, this study intended to assess the efficiency of various different production processes that occur among these stakeholders in Taiwan＇s NHI system. Methods A two-stage relational Data Envelopment Analysis （DEA） model is adopted to investigate the sub-process efficiencies of the health care resources held by 23 cities and counties through stages I or II, where the outputs of the first stage serve the inputs of the second. The dataset was collected from the annual reports published by the Department of health, Taiwan, China. Results Under the proposed framework, the efficiency of the whole process can be obtained from the product of productivity and allocative efficiency. Ten DMUs are efficient either in stages I or II, with only two DMUs being efficient with regard to both sub-processes. Conclusion The relational DEA model not only demonstrates the physical relationship between the whole process and the sub-process components, but also produces reliable outcomes in efficiency measurement among different stakeholders in Taiwan＇s NHI system.

关键词： national health insurance single-payer relational data envelopment analysis productivity allocative efficiency

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Public satisfaction with the quality of First health Facility Services in Indonesia: Does sociodemographic matter?

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Asian Pacific Journal of Tropical Medicine 2023年第9期16卷 409-417页

作者： Zainul Khaqiqi Nantabah Rofingatul Mubasyiroh Antonius Yudi Kristanto Lely Indrawati Astridya Paramita Dwi Hapsari Tjandrarini Agung Dwi Laksono national Research and Innovation Agency JakartaIndonesia Directorate of Production and Distribution of Medical Devices Ministry of HealthJakartaIndonesia

Objective:To investigate individual characteristics related to satisfaction with the quality of First health Facility Services(FHFS)in Indonesia.Methods:This cross-sectional study analyzes national representation data.Meanwhile,the study involved 9846 representative respondents in 2019.Respondent’s satisfaction with FHFS based on the five dimensions of service quality(SERVQUAL)is a dependent variable.Independent variables consist of sex,marital status,age,education,employment,insurance ownership,and economics.The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality.Results:77.3%Respondents were satisfied with FHFS,with the highest order of satisfaction dimensions being assurance(59.4%),empathy(57.3%),reliability(53.6%),responsiveness(52.7%),and then tangibility(49.1%).Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied(95%CI 1.17-1.87).Employees were 0.77 less likely than the unemployed to get satisfied(95%CI 0.70-0.86).Respondents with higher education was 0.82 less likely than those with primary education to be satisfied(95%CI 0.67-0.99).Meanwhile,respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied(95%CI 1.42-1.80).Moreover,the rich were 0.82 less likely than the poor to get satisfied(95%CI 0.73-0.92).Conclusions:Community satisfaction with FHFS is generally high,though some areas could be improved.Demographic factors are still strongly related to satisfaction ratings.The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society,ensuring that service satisfaction is rated as good by all groups.

关键词： health services quality Satisfaction national health insurance

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AN AHP MODEL FOR BRINGING EXPERTS TO CONSENSUS ON MEDICAL PAYMENT STANDARDS

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Journal of Systems Science and Systems Engineering 2006年第2期15卷 247-255页

作者： Yuan-Huei HUANG Pei-Yeh CHANG Chih-Young HUNG Kuei-Ing WANG King-Jen CHANG Department of Surgery Hsin-Chu General HospitalTaiwanChina Department of Pediatric Surgery Chang Gung Children’s HospitalChang Gung UniversityCollege of MedicineTaiwanChina Institute of Management of Technology National Chiao Tung UniversityTaiwanChina Department of Information Management Ming Hsin University of Science and TechnologyTaiwanChina Department of Surgery National Taiwan University HospitalTaiwanChina

Many countries with health insurance systems conduct periodic payment standards reform. How to reach consensus in setting payment standards among different specialties with different agendas has become a critical issue. The purpose of this study is to construct an analytic hierarchy process （AHP） model to obtain judgments from experts about the importance of ＂factors related to establishing payment standards in the national health insurance program＂. Under this goal, the first tier contains four evaluation aspects, and the second tier contains sixteen evaluation criteria divided into four groups The AHP model was then used to collect and combine the opinions of experts through an empirical study. The results can be directly used to formulate standard values as the basis for establishing payment standards. The results of our study strongly support that an AHP model is effective in forming a consensus among surgical specialists.

关键词： national health insurance Analytic Hierarchy Process payment standards

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