Since the beginning of National Health Insurance in 1995,the payment system had been changed from the initial paid-by-services to the paid-by-budgets in 2002, for the hope that the medical expense can be deduced under a reasonable system.
After 2004, the system was changed to the hospital self-managements, i.e., individual hospital budgets. The National Health Insurance encourages the hospitals to participate in this self-management and quality monitoring systems, which designed four major classified inspection exclusion items and twenty items of quality control scores. Ambulatory surgery is one of the exclusion items and the sixth quality indicator. It is a positive indicator, the higher in the ratio the more excellent in the quality. Ambulatory surgery score is excluded from the hospital budget, but still under the regulation of the national global budget.
This study is aimed at the central branch of National Health Insurance, exploring the utility rates of ambulatory surgery (file class 03) in the hospitals. The object is intend to find out: the differences of utility rates and its relation to the medical fee between the hospitals of pre- and post- self-management and the non-self-
management hospitals.
The study shows: As to the total number and fee of ambulatory surgery, there are all have a tendency of increase at various levels and belongs of hospitals. Since 2004, the indicators of ambulatory surgery all shows obvious increase either in the public and private hospitals in all of the self- management hospitals. It may be related to the policy and aim in the public hospitals. But the private hospitals pay more attention to the financial effects.
If the paid is higher in some medical services, they will shift to that services. The regional hospital shows the most obvious difference in the hospital level. Probably, the regional hospital itself is more profit tendency and can rapid response to the market requirements, then changes the content and item of services. The hospital economic behavior and management system are closely related to the hospital belongs and levels and it can influence the medical behaviors and outcomes.
