PMID- 26324511
OWN - NLM
STAT- MEDLINE
DCOM- 20151117
LR  - 20181202
IS  - 1945-7243 (Electronic)
IS  - 0046-9580 (Print)
IS  - 0046-9580 (Linking)
VI  - 52
DP  - 2015
TI  - Provider Behavior Under Global Budgeting and Policy Responses: An Observational 
      Study on Eye Care Services in Taiwan.
LID - 10.1177/0046958015601826 [doi]
LID - 0046958015601826
AB  - Third-party payer systems are consistently associated with health care cost 
      escalation. Taiwan's single-payer, universal coverage National Health Insurance 
      (NHI) adopted global budgeting (GB) to achieve cost control. This study captures 
      ophthalmologists' response to GB, specifically service volume changes and service 
      substitution between low-revenue and high-revenue services following GB 
      implementation, the subsequent Bureau of NHI policy response, and the policy 
      impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 
      were analyzed to study the changes in Simple Claim Form (SCF) claims versus 
      Special Case Claims (SCCs). The 3 study years represent the pre-GB period, 
      post-GB but prior to region-wise service cap implementation period, and the 
      post-service cap period, respectively. Repeated measures multilevel regression 
      analysis was used to study the changes adjusting for clinic characteristics and 
      competition within each health care market. SCF service volume (low-revenue, 
      fixed-price patient visits) remained constant throughout the study period, but 
      SCCs (covering services involving variable provider effort and resource use with 
      flexibility for discretionary billing) increased in 2005 with no further change 
      in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau 
      with the ophthalmology association and enforced by the association. This study 
      demonstrates that GB deployed with ongoing monitoring and timely policy responses 
      that are designed in collaboration with professional stakeholders can contain 
      costs in a health insurance-financed health care system.
CI  - (c) The Author(s) 2015.
FAU - Chang, Chao-Kai
AU  - Chang CK
AD  - Yuan-pei University, Taipei City, Taiwan, Republic of China Taiwan Nobel Medical 
      Institute, Taipei, Taiwan.
FAU - Xirasagar, Sudha
AU  - Xirasagar S
AD  - University of South Carolina, Columbia, USA sxirasag@mailbox.sc.edu 
      maiblian@cc.ncue.edu.tw.
FAU - Chen, Brian
AU  - Chen B
AD  - University of South Carolina, Columbia, USA.
FAU - Hussey, James R
AU  - Hussey JR
AD  - University of South Carolina, Columbia, USA.
FAU - Wang, I-Jong
AU  - Wang IJ
AD  - National Taiwan University, Taipei City, Taiwan, Republic of China.
FAU - Chen, Jen-Chieh
AU  - Chen JC
AD  - National Taiwan University, Taipei City, Taiwan, Republic of China.
FAU - Lian, Ie-Bin
AU  - Lian IeB
AD  - National Changhua University of Education, Taiwan, Republic of China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150830
PL  - United States
TA  - Inquiry
JT  - Inquiry : a journal of medical care organization, provision and financing
JID - 0171671
SB  - IM
MH  - Ambulatory Care Facilities/*economics/organization & administration
MH  - Budgets
MH  - Cost Control
MH  - Health Expenditures
MH  - Humans
MH  - Insurance Claim Review/statistics & numerical data
MH  - National Health Programs/economics/legislation & jurisprudence/*organization & 
      administration
MH  - Ophthalmology/*economics/organization & administration
MH  - Ownership/economics
MH  - Regression Analysis
MH  - Taiwan
MH  - Universal Health Insurance/economics/legislation & jurisprudence/*organization & 
      administration
PMC - PMC5813648
OTO - NOTNLM
OT  - game theory
OT  - global budgeting
OT  - provider behavior
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2015/09/02 06:00
MHDA- 2015/11/18 06:00
PMCR- 2015/08/30
CRDT- 2015/09/02 06:00
PHST- 2015/09/02 06:00 [entrez]
PHST- 2015/09/02 06:00 [pubmed]
PHST- 2015/11/18 06:00 [medline]
PHST- 2015/08/30 00:00 [pmc-release]
AID - 52/0/0046958015601826 [pii]
AID - 10.1177_0046958015601826 [pii]
AID - 10.1177/0046958015601826 [doi]
PST - epublish
SO  - Inquiry. 2015 Aug 30;52:0046958015601826. doi: 10.1177/0046958015601826. Print 
      2015.