Medical care is a highly professional service. Asymmetry of information between provider and patient is well documented. The change of payment method means changing incentive to providers. Taiwan Bureau of National Health Insurance has implemented new payment policies step by step since 1995. Those policy reforms results are subject of concern, intensive discussion and investigation.
Objective: our study analyzed effect of cap global budgeting on hospital management strategy, mainly on medical resources used in primary cesarean section paid under case payment.
Methods: We used data provided by the National Health Research Institute, named million sample data which is included randomized, follow up 1 million samples year 2000 and 2004, we extracted 2451 primary cesarean section patients and used independent T test, logistic regression and multiple regression to compared recourse used of cesarean section before and after the introduction of cap global budget payment.
Result: We analyzed logistic regression in hospital deliveries. Result has shown us cesarean section rate (32% in 2000 and 30% in 2004) declined (year 2004 OR=
0.86) among the hospitals after implemented hospital global budgeting. Even though cesarean
section point did not changed statistically significant but real cost declined NTD 3202 because of low floating point.
Conclusion: Financial incentives within healthcare payment systems are increasingly recognized as powerful drivers of hospital service use and may dictate the healthcare services provided to patients, regardless of clinical need.
Case payment is suffering low floating point value because after hospital global budgeting hospitals admission rate, services volume increased and each services value decreased. Physicians who performed not only cesarean section also other case payment procedures cannot do anything to maintain their income or
maximizing profit because their services value depends oon other physician‘s behavior. The results indicate the hospital strategy it to increase ward charge, the money goes to hospital, and to reduce drug fee, the money mainly paid to
pharmaceutical companies
