溫信財 *
2.3 System Flow Analysis
For our research goals, we designed the following system flow.
Step 1: Major medical order must be written into the health information system (HIS) and the IC card of the patient [11], when patients hold the IC Card to accept the high-tech examination.
Step2: Control software of health information system uploads the major medical order of the patient to IDC.
Step3: IDC verify and reply whether the patient had re-examination within 90 days. If the patient had re-examination, the mechanism would generate warning message.
Step4, 5,6: Physicians could request downloading the major medical orders of imaging from IDC.
Step 7,8,9: If the physicians consider that the patient still need to undergone re-examination, then he or she must
Figure6 Management report For BNHI
Table1 CT and MRI reused odds rate 2005Q1-2006Q3 Item
Same hospital
Different hospital
Odds Rate
Total amount
CT reused 17.92% 12.38% 5.54% NT$238,220,0005 MRI reused 12.40% 9.2% 3.2% NT$83,200,0006 (Data Source: [3]) unit: dollars cardholder, physician and BNHI. We ponder the study from national medical policy strategy aspect. With the NHI IC Cards being widely used and there is a powerful network infrastructure, Taiwan has the position to reduce the sharply growing high-tech re-examination rate when
many advanced countries still couldn’t solve the problem.
4、Discussion and Conclusion
It is no doubt that high-tech medical re-examination is a kind of medical waste. It is commonly believed that the number of diagnostic imaging performed is more than those actually needed for medical purpose [8]. Some examinations are really unnecessary or ineffective [19][20]. Therefore, moderate control and management is necessary. We propose a mechanism to refine current NHI IC card functions. The refined NHI IC card system not only provides for the privacy and protection of patient information but can also provide real-time management information of re-examination to BNHI, and to warn the physicians on-line that the patient may have undergone re-examination recently, and to share the diagnostic imaging among different hospitals. We believe that medical information transparency, publicity, moderate control and sharing mechanism is the one of the best approaches to confront the waste in medial finance. From Table1, We evaluate that the re-examination rate of CT would be reduced by 5.54%, and that of MRI would also decrease by 3.2% if the proposed mechanism were adopted. The total medical expenditure for the two examinations could save NT$ 321,420,000 every year.
Finally, we suggest BNHI to adopt the proposed mechanism and to elaborately consider the security problem during the evaluation. From many research papers and practice operations still suggest that the IC Card should be a great material carrier on security. It could elaborately tackle the security problems of certification, integrity and authority among the
5. Acknowledgement
The authors would like to thank BNHI IDC and KPBNHI of DOH in Taiwan ROC for supporting this research. In particular, the chief of the Information management office support the subject and the manager of the medical administration section assist in medical profession.
References
[1] A.A. Okunade, and V.N.R. Murthy, “Technology as a “major driver” of health care costs: a cointegration analysis of the Newhouse conjecture”, Journal of Health Economics, Vol. 21, No. 1, pp. 147-159, 2002.
[2] Bureau of National Health Insurance, ”Major Medical Order Instant system”, NHI Trial Part 89015405 Letter, 2000. (in Chinese)
[3] Bureau of National Health Insurance, ”Medical Payment Data Analysis System”, 2001. (in Chinese) [4] Bureau of National Health Insurance, ”Universal
Health Insurance to Pay the Medical Costs of Specific Screening Criteria Resource Sharing Pilot Program”, http://www.nhi.gov.tw/webdata/webdata.
5 The fee was NT$43,0000,040 when CT varied 1 %[6].
6 The fee was NT$26,000,000 when MRI varied 1%[6].
asp?menu=1&menu_id=26&webdata_id=940, 2004.
(Available on 2007/03/16)。(in Chinese) [5] Bureau of National Health Insurance , Kao-Ping
Branch, ”Management Reported for the First 333 Times”, 2007.(in Chinese)
[6] Bureau of National Health Insurance, “Bimonthly of National Health Insurance, Vol. 62, Bureau of National Health Insurance “, 2006 (in Chinese) [7] Control Yuan, “Notice to Correct the Central Health
Insurance Bureau to Correct provisions
[0932201199-1]”, http://www.cy.gov.tw/XMLPost/
browse.asp?tmpPage= 6, 2004. (Available on 2007/03/16). (in Chinese)
[8] F.M. Hall, “Overutilization of Radiological Examination”, Radiology, Vol. 120, pp. 443-448, 1976.
[9] H.G. Huang, ”Research Issues in Healthcare Information Systems”, Journal of Information Management, Vol. 9, No. S., 2002. (in Chinese) [10] H. Lo, “Antecedents and Consequences of the
Adoption and Expansion of New Medical
Technology in Hospitals”, Taiwan Journal of Public Health, Vol. 25, No. 5, pp. 385-391, 2005. (in Chinese)
[11] J.C. Liu, T. Tang, J.L. Wu, I. Hsu, S.C. Zong, C.
Huang, “Modeling Data Processing and Exception Management for National Health Insurance IC cards”, Department of Health commissioned the study for 2001, (DOH90-NH-005), 2001.(in Chinese)
[12] J.F. Lu and C.R. Hsieh, “An Analysis of the Market Structure and Development of Taiwan's Hospital Industry”, Taiwan Economic Review, Vol. 31, No. 1, pp. 107-153, 2003. (in Chinese)
[13] J.P. Newhouse, “Medical Care Cost: How Much Welfare Loss?”, Journal of Economic Perspectives, Vol. 6, No. 3, pp. 3-21, 1992.
[14] ---, “An Iconoclastic View of Health Cost Containment”, Health Affairs, Vol. 12, No. 5, pp.152-171, 1993.
[15] J.W. Huang, and T.W. Hou, “Design and Prototype of a Mechanism for Active On-Line Emerging /Notifiable Infectious Diseases Control, Tracking and Surveillance, Based on a National Healthcare Card System”, Computer Methods and Programs in Biomedicine, Vol.86, No, 3, pp. 161-170, 2007.
[16] M. Gaynor, and W.B. Vogt, “Antitrust and Competition in Health Care Markets”, Cambridge, Mass: NBER, 1999.
[17] M. Grossman, “On the Concept of Health Capital and the Demand for Health”. Journal of Political Economy, Vol. 80, pp.223-255, 1972.
[18] M. Noether, “Competition among Hospitals”, Journal of Health Economics, Vol. 7, No. 3, pp.
259-284, 1988.
[19] P. N. Cascade, E.W Webster, E.A. Kazerooni,
“Ineffective Use of Radiology: The Hidden Cost”, Am. J. Roentgenol, Vol. 170, No. 33, pp. 561-564, 1998.
[20] ---, “Unnecessary Imaging and Radiation Risk: The Perfect Storm for Radiologists”, J Am Coll Radiol ,Vol. 10, No 1,pp. 709-711, 2004.
[21] P.T. Kung, W.C. Tsai, C.L Yaung, K.P. Liao,
“Determinants of Computed Tomography and Magnetic Resonance Imaging Utilization in Taiwan”, International Journal Of Technology Assessment In Health Care Vol.21, No. 1, pp. 81-88, 2005.
[22] R. Allen, “Policy Implications of Recent Hospital Competition Studies”, Journal of Health Economics, Vol. 11, pp. 347-351, 1992.
[23] W. D. Tsai and I.H. Li “Hospital Nonprice Competition and Market Structure: An Empirical Study of Hospitals' Acquisition of High-tech
Medical Equipment”, Taiwan Economic Review, Vol.
30, No. 1, pp. 57-78, 2002. (in Chinese)