The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

THE INFLUENCE OF GLOBAL BUDGET SYSTEM ON THE MEDICAL RESOURCE UTILIZATION OF INTEGRATED DELIVERY SERVICES FOR VENTILATOR-DEPENDENT PATIENTS.

Hung Huei Ling; Chang Gung Memorial Hospital, Kaohsiung, Taiwan Hsueh, Mei-Ling1, Huei-Ling Hung1,2, Herng-Chia Chiu2, Ming-Hsien Huang3, Yu-Hsiu Chung1, Ching-Wan Tseng1,2,4

Background The Integrated Delivery System(IDS) integrates different levels of respiratory care and consists of intensive care units, respiratory care centers, respiratory care wards, and home care, which has been implemented for 10 years in Taiwan. During the 10 years, the Bureau of National Health Insurance(BNHI) made some revisions to the IDS, among which the most influential one is believed to be the Global Budget System(GBS) which was implemented on July 1, 2002. Method This retrospective study aimed to investigate the affect of GBS on the medical resource utilization of IDS for ventilator-dependent patients ( 21 days) by comparing the difference between the Group A:IDS(Integrated Delivery System) implementation Group B:IDS with GBS(Global Budget System) implementation for one to two years and Group C:IDS with GBS implementation for three to four years.The study subjects were patients selected from the BNHI from January 2001 to December 2008. A multiple linear regression analysis were utilized to investigate whether the medical resource utilization(total hospital stay, intensive care unit stay, days on ventilator, hospitalization expenses) for IDS patients was affected by the implementation of GBS. Result (1)The total hospital stay in Group C was more than Group A patients by 60.91days, achieving a significant correlation(P=0.015)(2)The intensive care unit stay was affected by the implementation of GBSwhich reduced by 7.64 days in the Group B than Group A patients(P=0.002)(3)GBS increased the days on ventilator more than 54.73 days in Group C by comparing with the patients in Group A(P=0.017)(4)The hospitalization expenses were also affected by GBS which were $266,298 higher for patients in Group C than those without GBS implementation in Group A(P=0.014). Conclusion It was observed that the accessibility to medical care for insured patients was unaffected by the implementation of hospital's GBS in the three groups.The medical resource utilization was however affected.The implementation of GBS reduced the length of intensive care unit stay and achieved the IDS goal of eliminating the predicament of hospital bed shortage for critically ill patients; but, also increased the number of days on ventilator and longer total hospital stay.
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