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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張睿詒 | |
| dc.contributor.author | Chiu-Ling Lai | en |
| dc.contributor.author | 賴秋伶 | zh_TW |
| dc.date.accessioned | 2021-05-17T09:14:18Z | - |
| dc.date.available | 2016-09-17 | |
| dc.date.available | 2021-05-17T09:14:18Z | - |
| dc.date.copyright | 2012-09-17 | |
| dc.date.issued | 2012 | |
| dc.date.submitted | 2012-08-16 | |
| dc.identifier.citation | 中文部分
中央健康保險局。(2011)。民國99年全民健康保險統計。台北市：行政院衛生署中央健康保險局。 行政院衛生署。(2012)。健保局自100年7月1日起試辦「論人計酬計畫」，讓民眾獲得更周全的整合照護。上網日期：101年5月27日。網址：http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=473&now_fod_list_no=11515&level_no=1&doc_no=8358。 林振坤。(2005)。運用全民健康保險資料比較不同風險校正診斷因子對個人門診醫療費用之預測。國立台灣大學醫療機構管理研究所碩士論文，台北市。 張育嘉、黎伊帆、汪芳國等。(2006)。全民健保實施總額預算制度之初步影響評估：以牙醫與西醫基層為例。台灣公共衛生雜誌, 25(2), 152-162。 張舒婷。(2005)。建構所有診斷資訊群組及其風險預測模式。國立台灣大學醫療機構管理研究所碩士論文，台北市。 張睿詒、賴秋伶。(2005)。風險校正因子：論人計酬醫療費用預測之基礎。台灣公共衛生雜誌，23(2)，91-99。 張睿詒。(2008)。發展整合用藥與診斷資訊之風險校正因子與多年期穩定性之探討。行政院國家科學委員會補助專題研究計畫。 梁亞文、陳芬如、鄭瑛琳。(2008)。台灣的可避免住院及其病患社經狀態。台灣公共衛生雜誌, 27(1), 81-90。 梁亞文、陳文意、林育秀等。(2011)。可避免住院研究回顧對台灣基層醫療照護的意涵。台灣公共衛生雜誌, 30(5), 409-421。 鄭守夏。(2011)。全民健保向論人支付邁進。台灣公共衛生雜誌, 30(1), 1-4。 賴秋伶。(2007)。建立全民健康保險醫療費用預測模型。行政院衛生署補助學生參與專題研究計畫。 謝孟甫、張睿詒。(2006)。處方資訊用於台灣風險校正模型之初探。台灣公共衛生雜誌，25(3)，189-200。 英文部分 Anderson, G. F., Steinber, E.P., Powe, N.R., et al. (1990). Setting payment rates for capitated systems: a comparison of various alternatives. Inquiry, 27, 225-33. Andersson, P. A., Varde, E., Diderichsen, F. (2000). Modelling of resource allocation to health care authorities in Stockholm county. Health Care Management Science, 3(2), 141-149. Averill, R. F., McCullough, E. C., Hughes, J. S., et al. (2009). Redesigning the Medicare inpatient PPS to reduce payments to hospitals with high readmission rates. Health Care Financing Review, 30(4), 1-15. Ash, A., Porell, F., Gruenberg, L., et al. (1989). Adjusting Medicare capitation payments using prior hospitalization data. Health Care Financing Review, 10(4), 17-29. Asthana, S., Gibson, A., Hewson, P., et al. (2011). General practitioner commissioning consortia and budgetary risk: evidence from the modeling of ‘fair share’ practice budgets for mental health. Journal of Health Services Research & Policy, 16(2), 95-101. Bailit, M. B. and Hughes, C. (2011). Key design elements of shared-savings payment arrangements. The Commonwealth Fund. Bazzoli, G. J., Dynan, L., Burns, L. R., et al. (2000). Is provider capitation working? Effects on physician-hospital integration and costs of care. Medical Care, 38(3), 311-324. Berenson, R. A. (2010). Shared savings program for accountable care organizations: a bridge to nowhere? The American Journal of Management Care , 16(10), 721-726. Berwick, D. M. (2011). Making good on ACOs’ promise-the final rule for the Medicare shared savings program. The New England Journal of Medicine, 365(19), 1753-1756. Brandt, N. (2008). Moving towards more sustainable healthcare financing in Germany. OECD economics department working paper No. 612. Breyer, F., Heineck, M., Lorenz, N. (2003). Determinants of health care utilization by German sickness fund members-with application to risk adjustment. Health Economics, 12(5), 367-376. Buchner, F. and Wasem, J. (2003). Needs for further improvement: risk adjustment in the German health insurance system. Health Policy, 65(1), 21-35. Bynum, J. P., Bernal-Delgado, E., Gottlieb, D., et al. (2007). Assigning ambulatory patients and their physicians to hospitals: a method for obtaining population-based provider performance measurements. Health Services Research, 42(1 Part I), 45-62. Carlsson L, Börjesson U, Edgren L. (2002). Patient based 'burden-of-illness' in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records. The International Journal of Health Planning and Management, 17(3), 269-282. Center of Medicare & Medicaid Services. (2012). Readmissions Reduction Program. CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed Jun 15, 2012. Chang, H. Y. and Weiner, J. P. (2010). An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan. BMC Medicine, 8, 7. Chang, L. and Hung, J. H. (2008). The effects of the global budget system on cost containment and the quality of care: experience in Taiwan. Health Services Management Research, 21(2),106-116. Chang, R. E., Lin, S. P., Aron, D. C. (2012). A pay-for-performance program in Taiwan improved care for some diabetes patients, but doctors may have excluded sicker ones. Health Affairs, 31(1), 93-102. Chang, R. E. and Lai, C. L. (2005). Using diagnosis-based risk adjustment models to predict individual healthcare expenditure under the National Health Insurance in Taiwan. Journal of Formosa Medical Association, 104(12), 883-90. Chen, T. J., Chou, L. F., Hwang, S. J. (2006). Patterns of ambulatory care utilization in Taiwan. BMC Health Services Research, 6(54), Chen, F. J., Laditka, J. N., Laditka, S. B., et al. (2007). Providers’ responses to global budgeting in Taiwan: what were the initial effects? Health Services Management Research, 20(2),113-120. Cheng, S. H., Chen, C. C., Chang, W. L. (2009). Hospital response to a global budget program under universal health insurance in Taiwan. Health Policy, 92(2-3), 158-164. Cheng, S. H., Lee, T. T., Chen, C. C. (2012). A longitudinal examination of a pay-for-performance program for diabetes care: evidence from a natural experiment. Medical Care, 50(2), 109-116. Chernichovsky, D. and van de Ven, W. P. (2003). Risk adjustment in Europe. Health Policy, 65(1), 1-3. Clark, D. O., Korff, M. V., Saunders, S. K., et al. (1995). A chronic disease score with empirically derived weights. Medical Care, 33(8), 783-795. Davis, K. and Guterman, S. (2007). Rewarding excellence and efficiency in Medicare payments. The Milbank Quarterly, 85(3), 449-468. De Brantes, F., Rastogi, A., Painter, M. (2010). Reducing potentially avoidable complications in patients with chronic diseases: the Prometheus payment approach. Health Services Research, 45(6 Pt 2), 1854-71. DeVore, S. and Champion, R. W. (2011). Driving population health through accountable care organizations. Health Affairs, 30(1), 41-50. Dixon, J., Smith P., Gravelle, H. et al. (2011). A person based formula for allocating commissioning funds to general practices in England: development of a statistical model. British Medical Journal, 343, d6608. Doran, T., Fullwood, C., Gravelle, H., et al. (2006). Pay-for-performance programs in family practices in the United Kingdom. The New England Journal of Medicine, 355(4), 375-384. Ellis, R. P., Pope, G. C., Lezzoni, L. I., et al. (1996). Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financing Review, 17(3), 101-127. Engstrom, S. G., Carlsson, L., Ostren, C. J., et al. (2006). The importance of comorbidity in analyzing patient costs in Swedish primary care. BMC Public Health 2006, 6, 36. Epstein, A. M. and Cumella, E. J. (1988). Capitation payment: using predictors of medical utilization to adjust rates. Health Care Financing Review, 10(1), 51-69. Fisher, E. S., Wennberg, J. E., Stukel, T. A., et al. Hospital readmission rates for cohorts of medicare beneficiaries in Boston and New Haven. The New England Journal of Medicine, 331(15), 989-995. Fisher, E. S., Wennberg, D. E., Stukel, T. A., et al. Variations in the longitudinal efficiency of academic medical centers. Health Affairs, Suppl Variation,VAR19-32. Fisher, E. S., Staiger, E. O., Bynum J. P., et al. (2006). Creating accountable care organizations: the extended hospital medical staff. Health Affairs, 26(1), w44-57. Fisher, E. S., McClellan, M. B., Bertko, J., et al. (2009). Fostering accountable health care: moving forward in Medicare. Health Affairs, 28(2), w219-231. Fisher, E. S. and Shortell, S. M. (2010), Accountable care organizations: accountable for what, to whom, and how. The Journal of the American Medical Association , 304(15), 1715-1716. Fishman, P. A., Goodman, M. J., Hornbrook, M. C., et al. (2003). Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Medical Care, 41(1), 84-99. Gilmer, T., Kronick, R., Fishman, P., et al. (2001). The Medicaid Rx model: pharmacy-based risk adjustment for public programs. Medical Care, 39(11), 1188-1202. Ginsburg, P. B. (2011). Spending to save- ACOs and the Medicare shared savings program. The New England Journal of Medicine, 364(22), 2085-2086. Glickman, S.W. and Peterson, E.D. (2009). Innovative health reform models: pay-for-performance initiative. The American Journal of Management Care,15, S300-305. Goldfield, N. I., McCullough, E. C., Hughes, J. S., et al. (2008). Identifying potentially preventable readmissions. Health Care Financing Review, 30(1), 75-91. Goodson, J. D., Bierman, A. S., Fein, O., et al. (2001). The future of capitation: the physician role in managing change in practice. Journal of General Internal Medicine, 16(4), 250-256. Goroll, A. H., Berenson, R. A., Schoenbaum, S. C., et al. (2007). Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. Journal of General Internal Medicine, 22(3), 410-415. Haywood, T. T., Kosel, K. C. (2011). The ACO model- A three-year financial loss? The New England Journal of Medicine, 364(14), e27. Hughes, J. S., Averill, R. F., Eisenhandler, J., et al. (2004). Clinical risk groups (CRGs). A classification system for risk-adjusted capitation-based payment and health care management. Medical Care, 42(1), 81-90. Iglehart, J. K. (2011). Assessing an ACO prototype- Medicare’s physician group practice demonstration. The New England Journal of Medicine, 364(3), 198-200. Jencks, S. F., Williams, M. V., Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. The New England Journal of Medicine, 360(14), 1418-1428. Kautter, J., Poope, G. C., Trisolini, M., et al. (2007). Medicare physician group practice demonstration design: quality and efficiency pay-for-performance. Health Care Financing Review, 29(1), 15-29. Kronick R, Dreyfus T, Lee L, et al. (1996). Diagnostic risk adjustment for Medicaid: the disability payment system. Health Care Financing Review, 17(3), 7-33. Kronick R, Gilmer T, Dreyfus T, et al. (2000). Improving health-based payment for Medicaid beneficiaries: CDPS. Health Care Financing Review, 21(3), 29-64. Kronick R, Gilmer T, Dreyfus T, et al. (2002). CDPS-Medicare: The chronic illness and disability payment system modified to predict expenditures for Medicare beneficiaries. Final report to CMS. Kuo, R. N., Chung, K. P., Lai, M. S. (2011). Effect of the pay-for-performance program for breast cancer care in Taiwan. The American Journal of Management Care , 17(5 Spec No), e203-e211. Kuo, R. N., Lai, M. S. (2010). Comparison of Rx-defined morbidity groups and diagnosis- based risk adjusters for predicting healthcare costs in Taiwan. BMC Health Services Research, 10, 126. Kuo, T. C., Zhao, Y., Weir, S., et al. (2008). Implications of comorbidity on costs for patients with Alzheimer disease. Medical Care, 46(8), 839-846. Lamer, L. M. (1999). Pharmacy costs groups: a risk-adjuster for capitation payments based on the use of prescribed drugs. Medical Care, 37(8), 824-830. Lamers, L. M. and van Vliet, R. C. (2003). Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands. Health Policy, 65(1), 49-62. Lamers, L. M. and van Vliet, R. C. (2004). The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation. Health Policy, 68(1), 113-121. Lee, T. T., Cheng, S. H., Chen, C. C., et al. (2010). A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment. The American Journal of Management Care , 16(1), 65-69. Lee , W. C. and Huang, T. P. (2008). Explanatory ability of the ACG system regarding the utilization and expenditure of the national health insurance population in Taiwan--a 5-year analysis. Journal of Chinese Medicine Association, 71(4), 191-199. Li, Y. H., Tsai, W. C., Khan, M., et al. (2010). The effects of pay-for-performance on tuberculosis treatment in Taiwan. Health Policy and Planning, 25(4), 334-341. Lin, W. D., Chang, R. E., Hsieh, C. J., et al. (2003). The development of a risk-adjusted capitation model based on principal inpatient diagnoses in Taiwan. Journal of Formosa Medical Association, 102(9), 637-643. Luft, H. S. (2010). Becoming accountable- opportunities and obstacles for ACOs. The New England Journal of Medicine, 353(15), 1389-1391. McNair, P. D., Luft, H. S., Bindman, A. B. (2009). Medicare’s policy not to pay for treating hospital-acquired conditions: the impact. Health Affairs, 28(5), 1485-1493. Newhouse, J. P., Manning, W. G., Keeler, E. G., et al. (1989). Adjusting capitation rates using objective health measure and prior utilization. Health Care Financing Review, 10(3), 41-54. Newhouse, J. P. (1996). Reimbursing health plans and health providers: efficiency in production versus selection. Journal of Economic Literature, 34(3), 1236-1263. O’Brien, S. M., DeLong, E. R., Peterson, E. D. (2008). Impact of case volume on hospital performance assessment. Archives of Internal Medicine, 168(12), 1277-1284. Orueta, J. F., Lopez-De-Munain, .J, Báez, K., et al. (1999). Application of the ambulatory care groups in the primary care of a European national health care system: does it work? Medical Care, 37(3), 238-248. Orueta, J. F., Urraca, J., Berraondo, I., et al. (2006). Adjusted clinical groups (ACG) explainthe utilization of primary care in Spain based on information registered in the medical records: a cross-sectional study. Health Policy,76(1), 38-48. Parker, J. P., McCombs, J. S., Graddy, E. A. (2003). Can pharmacy data improve prediction of hospital outcomes? Comparisons with a diagnosis-based comorbidity measure. Medical Care, 41(3), 407-419. Pham, H. H., Schrag, D., O’Malley, A. S., et al. Care patterns in Medicare and their implications for pay for performance. The New England Journal of Medicine, 356(11), 1130-1139. Pope, G. C., Adamache, K. W., Walsh, E. G., et al. (1998). Evaluating alternative risk adjusters for Medicare. Health Care Financing Review, 20(2), 109-129. Pope, G. C., Kautter, J., Ellis, R. P., et al. (2004). Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financing Review, 25(4), 119-141. Pope, G. C. and Kautter, J. (2011). Minimum savings requirements in shared savings provider payment. Health Economics, DOI: 10.1002/hec.1793. Rice, N. and Smith, P. C. (2001). Capitation and risk adjustment in health care financing: an International progress report. Milbank Quarterly, 79(1), 81-113. Robst, J., Levy, J. M., Ingber, M. J. (2007). Diagnosis-based risk adjustment for Medicare prescription drug plan payments. Health Care Financing Review, 28(4), 15-30. Rosenthal, M. B., Landon, B. E., Howitt, K., et al. (2007). Climbing up the pay-for-performance learning curve: where are the early adopters now? Health Affairs, 26(6), 1674-1682. Ross, J. S. and Siu, A. L. (2007). The importance of population-based performance measures. Health Services Research, 42(1 Part I), 1-6. Schang, L. (2009). Morbidity-based risk structure compensation. Health Policy Monitor. Schokkaert, E., Dhaene, G., Van de Voorde, C. (1998). Risk adjustment and the trade-off between efficiency and risk selection: an application of the theory of fair compensation. Health Economics, 7(5), 465-480. Schokkaert, E. and Van de Voorde, C. (2000). Risk adjustment and the fear of markets: the case of Belgium. Health Care Management Science, 3(2), 121-130. Schokkaert, E. and Van de Voorde, C. (2003). Belgium: risk adjustment and financial responsibility in a centralized system. Health Policy;65(1), 5-19. Schokkaert, E. and Van de Voorde, C. (2004). Risk selection and the specification of the conventional risk adjustment formula. Journal of Health Economics, 23(6), 1237-1259. Scott, I. A. (2007). Pay for performance in health care: strategic issues for Australian experiments. The Medical Journal of Australia,187(1), 31-35. Shen, Y. and Ellis, R. P. (2002). How profitable is risk selection? A comparison of four risk adjustment models. Health Economics,11(2), 165-174. Smith, P. (2008). Resource allocation and purchasing in the health sector: the English experience. Bulletin of World Health Organization, 86(11), 884-888. Starfield, B., Weiner, J., Mumford, L., et al. (1991). Ambulatory care groups: a categorization of diagnoses for research and management. Health Service Research, 26(1), 53-74. The Agency for Healthcare Research and Quality. (2012). Prevention Quality Indicators Technical Specifications - Version 4.4. van Barneveld, E. M., Lamers, L. M., van Vliet, R. C., et al. (2001). Risk sharing as a supplement to imperfect capitation: a tradeoff between selection and efficiency. Journal of Health Economics, 20(2), 147-168. van de Ven, W. P. and Ellis, R. P. (2000). Risk adjustment in competitive health plan markets. In: Newhouse JP, Culyer AJ, eds. Handbook of health economics. Amsterdam: Elservier Science, 1, 755-845. ven de Ven, W. P., Beck, K., Van de Voorde, C., et al. (2007). Risk adjustment and risk selection in Europe: 6years later. Health Policy, 83(2-3),162-179. ven de Ven, W. P., van Vliet, R. C., Lamers, L. M. (2004). Health-adjusted premium subsidies in the Netherlands. Health Affairs, 23(3), 45-55. van Vilet, R. C. and van de Ven, W. P. (1992). Towards a capitation formula for competing health insurers. An empirical analysis. Social Science and Medicine, 34(9), 1035-1048. van Vilet, R. C. and van de Ven, W. P. (1993). Capitation payments based on prior hospitalizations. Health Economics, 2(2), 177-188. Weinberg, D. B., Gittell, J. H., Lusenhop, R. W., et al. (2007). Beyond our walls: impact of patient and provider coordination across the continuum on outcomes for surgical patients. Health Services Research, 42(1 Part I), 7-24. Wennberg, J. E., Fisher, E. S., Stukel, T. A., et al. (2004). Use of Medicare claims data to monitor provider-specific performance among patients with severe chronic illness. Health Affairs, Suppl Variation,VAR5-18. Wennberg, J. E., Fisher, E. S., Baker, L., et al. (2005). Evaluating the efficiency of California providers in caring for patients with chronic illnesses. Health Affairs, Suppl Web Exclusives:W5-526-43. Weiner, J. P., Starfield, B. H., Steinwachs, D. M., et al. (1991). Development and application a population-oriented measure of ambulatory care case-mix. Medical Care, 29(5), 452-453. Weiner, J. P., Parente, S. T., Garnick, D. W., et al. Variation in office-based quality. A claims-based profile of care provided to Medicare patients with diabetes. The Journal of the Medical Association, 273(19), 1503-1508. Weiner, J. P., Dobson, A., Maxwell, S. L., et al. (1996). Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health care Financing Review, 17(3), 77-99. Weiner, J. P., Tucker, A. M., Collins, A. M., et al. (1998). The development of risk-adjusted capitation payment system: the Maryland Medicaid model. Journal of Ambulatory Care Management, 21(4), 29-52. Weng, H. C. (2005). Impacts of a government-sponsored outpatient-based disease management program for patients with asthma: a preliminary analysis of national data from Taiwan. Disease Management, 8(1), 48-58. WHO. (2007). Provider payments and cost-containment lessons from OECD countries. Technical briefs for policy-makers, No.2. Winkelman, R. (2007). A comparative analysis of claims-based tools for health risk assessment. Final report to the Society of Actuaries. Zhao, Y., Ellis, R. P., Ash, A. S., et al. (2001). Measuring population health risks using inpatient diagnoses and outpatient pharmacy data. Health Service Research, 36(6), 180-193. Zhao, Y., Ash, A. S., Ellis, R. P., et al. (2005). Predicting pharmacy costs and other medical costs using diagnoses and drug claims. Medical Care, 43(1), 34-43. Zweifel, P. (2011). Swiss experiment shows physicians, consumers want significant compensation to embrace coordinated care. Health Affairs, 30(3), 510-518. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/6512 | - |
| dc.description.abstract | 研究背景
為解決論量計酬醫療服務過度提供且缺乏照護協調性，以及論人計酬可能產生限制醫療服務與醫療服務提供者過度承擔財務風險等問題，發展課責式照護組織為給付單位的課責基礎支付模式，已成為各國最主要的支付制度改革政策之一。 研究目的 運用醫療費用申報資料建構課責式照護組織，並比較採用不同風險校正論人計酬設定目標預算，以及可避免醫療利用作為分享節餘機制對課責式照護組織財務風險影響，以評估發展全民健康保險課責基礎支付模式的可行性。 研究方法 本研究利用全民健康保險研究資料庫100萬人承保抽樣歸人檔，以2006年至2008年全年且2009年至少有1個月在保之保險對象為研究對象，並以其醫療利用之就醫型態資料發展課責式照護組織建構與病人歸屬方法。另亦比較採用性別年齡組成的人口模式與由人口模式及診斷資料組成的健康基礎模式作為風險校正論人計酬公式設定目標預算，以及運用可避免住院設算分享節餘，對課責式照護組織財務風險之影響。 結果 本研究建構88個課責式照護組織，共計847,811 (98%)研究樣本可以歸屬至門診主要照護提供者及課責式照護組織，研究樣本2008年醫療費用平均68%係來自於歸屬之課責式照護組織。運用風險校正論人計酬模式設定預算，課責式照護組織照護人數規模擴大，將提升風險校正模式醫療費用預測力並降低財務風險。運用健康基礎模式較人口模式平均財務風險可降低約2%醫療費用。採用可避免住院作為分享節餘機制平均財務收入可增加約4%醫療費用。 結論 本研究顯示全民健康保險對象就醫型態可作為建構課責式照護組織之基礎，發展課責基礎支付模式具有實務可行性。而採用較精確的健康基礎風險校正模式設定預算將增加預算分配公平性並降低財務風險，以可避免醫療利用作為分享節餘機制，將有助於獎勵照護成效改善並降低財務風險不確定性。 | zh_TW |
| dc.description.abstract | Background
The development of an accountability-based payment model to foster the creation of accountable care organizations (ACOs), which consist of providers who are held responsible for both the quality and cost of care, has become one of the most promising payment reform strategies. Purpose Our purpose is to develop a method for assigning National Health Insurance (NHI) enrollees and the providers who serve them to ACOs. Additionally, we will simulate the potential financial risk of the risk-adjusted capitation payment model used in setting budget targets and the potentially avoidable costs (PACs) used in the calculation of shared savings for ACOs. Methods We use a random sample of one million (5%) NHI enrollees from the National Health Insurance Research Database. Each NHI enrollee was assigned to a predominant ambulatory provider and an ACO based on the beneficiary's care pattern from 2006 to 2008. Demographic and health-based risk adjustment models were used to set capitation-based budgets and compare the financial risks. Financial risk is calculated as the likelihood that an ACO's actual medical costs exceed or fall short of its budget. Preventable hospitalizations were used to estimate the PACs and were calculated as potential savings for ACOs. Results A total of 88 ACOs were formed, and 847,811 (98%) enrollees were assigned to a specific provider and ACO. Two-thirds of health care services were billed by the assigned ACO in 2008. Enlarging the population size of ACOs will increase the accuracy of the risk adjustment model and reduce the financial risks to the ACOs. Using a health-based risk adjustment model to set capitation-based budgets, the average financial risk for each ACO will decrease by approximately 2% of the medical costs of the demographic model. Using preventable hospitalizations to calculate the potential savings, the average expected cost savings were approximately 4% of the medical costs for each ACO. Conclusions The development an accountability-based payment model for NHI is practical and feasible. This model would use claims data to assign virtually all enrollees to empirically defined ACOs that can be held accountable for their cost and quality of care. Adopting a health-based risk adjustment model for setting budgets and using PACs to calculate shared savings were critical to improving the equity of budget allocations and diminishing the financial risk among the ACOs. | en |
| dc.description.provenance | Made available in DSpace on 2021-05-17T09:14:18Z (GMT). No. of bitstreams: 1 ntu-101-D91843002-1.pdf: 709760 bytes, checksum: d49079598b096f45e70c5c396ed34f59 (MD5) Previous issue date: 2012 | en |
| dc.description.tableofcontents | 目 錄
口試委員會審定書……………………………………………………………………i 致謝……………………………………………………………………………………ii 中文摘要……………………………………………………………………………iii 英文摘要………………………………………………………………………………iv 圖目錄…………………………………………………………………………………vii 表目錄…………………………………………………………………………………viii 第一章 緒論…………………………………………………………………………1 第一節 研究背景…………………………………………………………………1 第二節 研究目的…………………………………………………………………8 第三節 研究重要性………………………………………………………………9 第二章 文獻探討……………………………………………………………………10 第一節 課責式照護組織支付模式……………………………………………10 第二節 病人歸屬方法…………………………………………………………13 第三節 論人計酬分配模式……………………………………………………16 第四節 健康基礎風險校正模式………………………………………………24 第五節 可避免醫療利用………………………………………………………41 第三章 研究方法……………………………………………………………………44 第一節 研究設計與研究假說…………………………………………………44 第二節 研究材料………………………………………………………………46 第三節 分析方法………………………………………………………………51 第四章 研究結果……………………………………………………………………54 第一節 描述性統計分析………………………………………………………54 第二節 建構課責式照護組織…………………………………………………64 第三節 風險校正論人計酬……………………………………………………71 第四節 可避免醫療利用………………………………………………………79 第五節 課責基礎支付模式財務風險…………………………………………83 第五章 討論…………………………………………………………………………90 第一節 重要結果討論…………………………………………………………90 第二節 研究限制………………………………………………………………96 第三節 結論與建議……………………………………………………………98 參考文獻……………………………………………………………………………100 | |
| dc.language.iso | zh-TW | |
| dc.subject | 課責式照護組織 | zh_TW |
| dc.subject | 財務風險 | zh_TW |
| dc.subject | 風險校正 | zh_TW |
| dc.subject | 論人計酬 | zh_TW |
| dc.subject | 可避免住院 | zh_TW |
| dc.subject | preventable hospitalization | en |
| dc.subject | financial risk | en |
| dc.subject | accountable care organization | en |
| dc.subject | risk adjustment | en |
| dc.subject | capitation | en |
| dc.title | 發展台灣全民健康保險課責基礎支付模式 | zh_TW |
| dc.title | Developing An Accountability-Based Payment Model for Taiwan’s National Health Insurance | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 100-2 | |
| dc.description.degree | 博士 | |
| dc.contributor.oralexamcommittee | 楊志良,江東亮,鄭守夏,周麗芳 | |
| dc.subject.keyword | 財務風險,風險校正,論人計酬,可避免住院,課責式照護組織, | zh_TW |
| dc.subject.keyword | financial risk,risk adjustment,capitation,preventable hospitalization,accountable care organization, | en |
| dc.relation.page | 113 | |
| dc.rights.note | 同意授權(全球公開) | |
| dc.date.accepted | 2012-08-16 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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