Has cost containment after the National Health Insurance system been successful: Determinants of Taiwan hospital costs
AbstractTaiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).
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Bibliographic InfoArticle provided by Elsevier in its journal Health Policy.
Volume (Year): 85 (2008)
Issue (Month): 3 (March)
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Web page: http://www.elsevier.com/locate/healthpol
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- Jeffrey A. Wurgler & Malcolm P. Baker, 2001.
"Market Timing and Capital Structure,"
Yale School of Management Working Papers
ysm181, Yale School of Management.
- Di Matteo, Livio & Di Matteo, Rosanna, 1998. "Evidence on the determinants of Canadian provincial government health expenditures: 1965-1991," Journal of Health Economics, Elsevier, vol. 17(2), pages 211-228, April.
- S. Illeris & G. Akehurst, 2001. "Introduction," The Service Industries Journal, Taylor & Francis Journals, vol. 21(1), pages 1-4, January.
- Hansen, Paul & King, Alan, 1996. "The determinants of health care expenditure: A cointegration approach," Journal of Health Economics, Elsevier, vol. 15(1), pages 127-137, February.
- Chang, Hsihui & Cheng, Mei-Ai & Das, Somnath, 2004. "Hospital ownership and operating efficiency: Evidence from Taiwan," European Journal of Operational Research, Elsevier, vol. 159(2), pages 513-527, December.
- Chiang, Tung-liang, 1997. "Taiwan's 1995 health care reform," Health Policy, Elsevier, vol. 39(3), pages 225-239, March.
- Martin, Stephen & Smith, Peter, 1996. "Explaining variations in inpatient length of stay in the National Health Service," Journal of Health Economics, Elsevier, vol. 15(3), pages 279-304, June.
- Di Matteo, Livio, 2000. "The determinants of the public-private mix in Canadian health care expenditures: 1975-1996," Health Policy, Elsevier, vol. 52(2), pages 87-112, June.
- Evans III, John H. & Hwang, Yuhchang & Nagarajan, Nandu J., 2001. "Management control and hospital cost reduction: additional evidence," Journal of Accounting and Public Policy, Elsevier, vol. 20(1), pages 73-88.
- Philip E. Berger & Eli Ofek & David Yermack, 1996.
"Managerial Entrenchment and Capital Structure Decisions,"
New York University, Leonard N. Stern School Finance Department Working Paper Seires
96-14, New York University, Leonard N. Stern School of Business-.
- Berger, Philip G & Ofek, Eli & Yermack, David L, 1997. " Managerial Entrenchment and Capital Structure Decisions," Journal of Finance, American Finance Association, vol. 52(4), pages 1411-38, September.
- Chang, Hsihui & Chang, Wen-Jing & Das, Somnath & Li, Shu-Hsing, 2004. "Health care regulation and the operating efficiency of hospitals: Evidence from Taiwan," Journal of Accounting and Public Policy, Elsevier, vol. 23(6), pages 483-510.
- Di Matteo, Livio, 2005. "The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time," Health Policy, Elsevier, vol. 71(1), pages 23-42, January.
- Chang, Hsi-Hui, 1998. "Determinants of Hospital Efficiency: the Case of Central Government-owned Hospitals in Taiwan," Omega, Elsevier, vol. 26(2), pages 307-317, April.
- Shin-Yi Chou & Jin-Tan Liu & James K. Hammitt, 2004. "National Health Insurance and Technology Adoption: Evidence from Taiwan," Contemporary Economic Policy, Western Economic Association International, vol. 22(1), pages 26-38, 01.
- Cairns, John A. & Munro, Jill, 1992. "Why does length of stay vary for orthopaedic surgery?," Health Policy, Elsevier, vol. 22(3), pages 297-306, October.
- Zimmer, Zachary & Martin, Linda G. & Lin, Hui-Sheng, 2005. "Determinants of old-age mortality in Taiwan," Social Science & Medicine, Elsevier, vol. 60(3), pages 457-470, February.
- Chou, Y. J. & Staiger, Douglas, 2001. "Health insurance and female labor supply in Taiwan," Journal of Health Economics, Elsevier, vol. 20(2), pages 187-211, March.
- Seshamani, Meena & Gray, Alastair M., 2004. "A longitudinal study of the effects of age and time to death on hospital costs," Journal of Health Economics, Elsevier, vol. 23(2), pages 217-235, March.
- Chiang, Yu-Mei & Chang, Yuhsuan, 2012. "Stress, depression, and intention to leave among nurses in different medical units: Implications for healthcare management/nursing practice," Health Policy, Elsevier, vol. 108(2), pages 149-157.
- Li Chang & Chi-Ping Hou, 2011. "Does a National Health Insurance System Enhance Quality of Care and Contain Cost?-An Empirical Investigation of the National Health Insurance System in Taiwan," Review of Economics & Finance, Better Advances Press, Canada, vol. 1, pages 32-42, November.
- Chang, Shyr-Juh & Hsiao, Hsing-Chin & Huang, Li-Hua & Chang, Hsihui, 2011. "Taiwan quality indicator project and hospital productivity growth," Omega, Elsevier, vol. 39(1), pages 14-22, January.
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