Efficiency, Quality and Equity of hospital service under multiple health insurance payment environment

Abstract

The purposes of this study were to assess the impacts of insurance payment methods on quality, equity and efficiency of health care services. Electronic database and hard copy of medical records from three public hospitals during 2003-2005 fiscal years were used in the assessment. Acute low back pain, acute upper gastrointestinal bleeding (AUGIB), epilepsy and lung cancer were employed as tracer diseases. Chi- square was used to assess the effects of payment methods on access to care and quality dimension of practice patterns. Shorrocks index was applied to measure inequality of drug cost of treatment in each tracer disease. Cost-effectiveness technique was used to assess impacts of payment methods on efficiency of health care services. It was found that new drugs, drugs in dosage form with high technology and high cost equipment were prescribed to patients using open-ended payment method in statically significant higher percentage than for patients covered by close-ended payment system. However, there was no difference in the access to required drugs, to supportive drugs and to gastroscope among patients with any insurance systems. Furthermore, there was no significant associate between the payment methods and the adherence to the critical recommendations of standard practice guidelines. By contrast, fewer open-ended paying epileptic patients suffered ADRs and received better management than those in insurance scheme using close-ended payment method. Shorrocks index on the cost of drug treatment indicated inequality among patients with different payment schemes. Better efficiency was found in the treatment of epilepsy for service in open-ended payment scheme, and in the treatment of UGIB and lung cancer in close-ended schemes. Evidence form this study indicates that payment methods have impacts on access to high cost services with drugs appear to be the first target of cost control.