| Taiwan's National Health Insurance implemented hospital-level global budgeting since July, 2002. There are some concerns that global budgeting will impact the inpatient care performance of hospital differently by hospital levels, since the capability of different levels of hospitals to control health care spending varies. Literature suggests that hospital will aggressively compete with one another to provide more services in order to maintain their share of income in a fixed budget region.; To address this issue, this study addressed three research questions to explore the impacts of global budgeting on inpatient care performance, for controlling hospital characteristics, competition, and environment factors. The study used two diagnoses with distinct clinical implications, pneumonia as a condition allowing substantial provider discretion in admission and discharge decision-making and hip fracture as a condition that is less amenable to clinical discretion. This study examines differences in care and services indicators for these two conditions.; Descriptive and multiple regression analyses were performed to compare care and services provided for these conditions in two six-month periods, before and after global budgeting. Data from the National Health Insurance database and hospital database were used, covering all hospitals operational in both study periods, excluding psychiatric hospitals.; There are three important study findings. First, the average length of stay and average fee per discharge increased after implementing global budget scheme. Second, different types of hospitals responded to global budgeting differently. Third, it shows that provider can manipulate the services when the situation permits discretion to make choices. These research findings suggest that policymakers need to carefully monitor the impact of global budgeting on disadvantaged hospitals and evaluate their important role the integrity of health care system. In addition, a sound system needs to be established in order to monitor and regulated health service utilization to prevent wastage of health care resources caused by wasteful competition under global budgeting. |
