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Biomedical subjects

Ming-Chin Yang

Publications and source records attributed to Ming-Chin Yang.

9 recordsLinked to original sources
PubMed2006

Financial assessment of a picture archiving and communication system implemented all at once.

The objective of this study was to determine the differential cost between film-based radiology and a hospital-wide picture archiving and communication system (PACS) implemented all at once. The cash flow and running costs of PACS and film-based operation were measured over an 8-year time horizon. When the hospital-wide PACS was implemented over a short period, there was instant conversion into digital film and archives. The net present value (NPV) for PACS operation is US $1,598,698, whereas the NPV for film-based operation is US $2,083,856, indicating a net saving of US $485,157. The payback period is 4 years. The costs of computed radiography and image plates account for 40% of the initial capital expenditure in PACS implementation, followed by computer hardware (30%) and software (9%) costs. Our experience shows that implementation of hospital-wide PACS all at once can produce cost savings. For hospitals intending to go filmless, this study offers a model for financial evaluation of PACS to help in decision making.

Analog-Digital Conversion↗
PubMed2006

Impacts of cost containment strategies on pharmaceutical expenditures of the National Health Insurance in Taiwan, 1996-2003.

INTRODUCTION: Pharmaceutical expenditure (PE) of the National Health Insurance (NHI) programme in Taiwan grew from 62.2 billion Taiwan new dollars (NT dollars) in 1996 to NT94.5 dollars billion in 2003.The government has been introducing many strategies to control PE since the inception of NHI including price adjustment based on the prices of international products or existing products (inter-brands comparison), or market price and volume survey; delegation of financial responsibility to regional bureaux; co-payment for outpatient drugs; generic grouping (the reference pricing scheme based on chemical equivalence); a global budget payment system for clinics and hospitals; and reduction in the flat daily payment rate of the drugs for clinics. The aim of this study was to evaluate the impact of these cost containment strategies on the PE of the NHI programme from 1996 to 2003. METHODS: To take the growth and seasonal trends of monthly PE into consideration, Box and Tiao's time-series event intervention analysis based on the Box-Jenkins auto-regressive integrated moving-average model was applied to evaluate the impact of various cost containment strategies on total and subsector (outpatient, inpatient, clinic and hospital sectors) PE. Monthly data of PE of the NHI programme from 1996 to 2003 (the dependent variables) were obtained from the Bureau of the NHI. Drugs prescribed by dentists and Chinese medical doctors at outpatient departments were excluded. RESULTS: After fitting the patterns of time series and controlling for the calendar effect of the Chinese New Year and the severe acute respiratory syndrome outbreak in 2003, three strategies (generic grouping, delegation of financial responsibility and reduction of the flat payment rate of clinics) were significantly associated with a reduction in PE. However, the hospital global budget strategy offset partial savings from these three strategies. Cumulative savings during the study period were estimated to be NT25.442 dollars billion (US0.80 dollars billion). Of all the strategies, generic grouping was the most effective although it had less effect on the clinic subsector. Neither drug co-payment nor price adjustment based on the international or inter-brand price comparison had significant impacts on PE. CONCLUSION: Generic grouping, reduction of the flat payment rate and delegation of financial responsibility were effective in controlling PE. A global budget alone would be unable to control PE without other direct financial incentives. Neither drug co-payment nor brand-specific price adjustment based on prices of international/existing products had a significant impact on PE.

Cost Control↗
PubMed2005

Factors contributing to patient dumping in Taiwan.

OBJECTIVE: Little research has been carried out to explore the issues surrounding patient dumping outside of the US. This study, therefore, uses a national research survey to examine the factors contributing to patient dumping within Taiwan. METHODS: A self-administered postal survey was undertaken to assess the prevalence of patient dumping in Taiwan, with the study subjects being superintendents of general hospitals. Data from the Bureau of Medical Affairs at the Department of Health in Taiwan were used in conjunction with the Taiwan National Health Insurance Research Database (NHIRD) to obtain estimates of factors potentially contributing to patient dumping. A multiple logistic regression analysis was performed to determine the relationships between the perceived extent of patient dumping occurring within the respondents' healthcare networks, as well as other factors, including the total number of hospitals, total number of hospital beds, the percentages of beds in public, for-profit and teaching hospitals (vis-à-vis all hospital beds), discharges, discharges covered under the case payment system, transferred inpatients, and the perceived degree of competition within each healthcare market. RESULTS: A total of 485 survey questionnaires were distributed, of which 251 were returned, giving a response rate of 51.75%. The responses from 29.9% of the sample group indicated that the perceived extent of patient dumping occurring in their service area was 'serious' or 'very serious'. The regression analysis showed that after controlling for other factors, the superintendents' perceived extent of the patient dumping occurring within their healthcare networks was positively related to the total number of patients covered under the case payment system, the total number of discharged patients, the extent of healthcare market competition and the number of respondent's hospital beds. CONCLUSIONS: We conclude from our findings that, under the National Health Insurance system, patient dumping is a widespread problem within Taiwan's healthcare industry.

Health Services Research↗
PubMed2004

Opinions of hospital administrators toward the prevalence of patient dumping in Taiwan.

BACKGROUND: The purposes of this paper were to examine whether patient dumping has occurred under the National Health Insurance and to explore hospital administrators' attitudes toward the practice of patient dumping in Taiwan. METHODS: The study subjects were administrators in general hospitals that were accredited by the Taiwan Joint Commission on Hospital Accreditation as medical centers, regional hospitals, or district teaching hospitals in the years 2000 and 2001. A self-administered postal survey was conducted using a structured questionnaire mailed to 128 administrators in general hospitals. RESULTS: Of the respondents, 83 of 99 (83.8%) administrators perceived that patient dumping did occur in their service areas to a certain degree regardless of their hospital location, hospital level, or hospital ownership. A total of 67 of 74 (90.5%) administrators who attempted to answer the question on the prevalence of patient dumping perceived that different percentages (mean=13.27%) of hospitals transferred patients solely on economic considerations in their service areas. In addition, this study found that no statistically significant relationships existed between the administrators' perceived percentage of emergency patients received by their hospitals and hospital characteristics. However, there was a statistically significant relationship between the perceived percentage of inpatients received and hospital level (p = 0.007). CONCLUSION: According to the results of this study, we concluded that patient dumping is a serious and widespread problem in the healthcare industry in Taiwan. Patient dumping can jeopardize patient health and impair the financial integrity of receiving hospitals. Implementation of a case payment system may worsened the situation in Taiwan.

Attitude of Health Personnel↗
PubMed2003

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.

Adolescent↗
PubMed2002

National health insurance expenditure for adult beneficiaries in Taiwan in their last year of life.

BACKGROUND AND PURPOSE: The cost of health care in the last year of life is a major issue of health services research. The purposes of this study were to examine health care use and expenditure under National Health Insurance (NHI) by Taiwanese adults in the last year of life, and to compare their results with those of randomly selected survivors. METHODS: A total of 9,369 adult decedent NHI beneficiaries were selected from NHI enrollee files and the Death Certificate data file for 1999. To compare expenses with those of patients without fatal illness, 10,000 randomly sampled adult beneficiaries of NHI who were alive on December 31, 1999, were selected as a survival group. NHI reimbursement and utilization information for these decedents and survivors were obtained by linking these samples to NHI claims files. RESULTS: The total NHI expenditure in the last year of life for the 9,369 decedents was US$71.6 million. About 54.5% of all medical expenses in the last year of life were incurred in the last 3 months of life. Nephritis and cancer were the most expensive causes of death, with per capita expenses of US$15,220 and US$10,828, respectively. The average expenses for survivors increased with age, while that for decedents increased with age from the 20- to 44-year age group to the 45- to 64-year age group, then decreased for decedents aged 65 and over. The age-dependent pattern of decreasing expenses with increasing age was found in cancer deaths for all age groups and in elderly decedent groups for most causes of death. CONCLUSIONS: This study demonstrated the relatively large amount of health care resources used by Taiwanese NHI participants in their last year of life and suggests the importance of greater awareness of the implications of allocation of medical care resources for terminally ill patients by policymakers and health care providers.

Adult↗
PubMedDate not supplied

Using path analysis to examine causal relationships among balanced scorecard performance indicators for general hospitals: the case of a public hospital system in Taiwan.

Examining whether the causal relationships among the performance indicators of the balanced scorecard (BSC) framework exist in hospitals is the aim of this article. Data were collected from all twenty-one general hospitals in a public hospital system and their supervising agency for the 3-year period, 2000-2002. The results of the path analyses identified significant causal relationships among four perspectives in the BSC model. We also verified the relationships among indicators within each perspective, some of which varied as time changed. We conclude that hospital administrators can use path analysis to help them identify and manage leading indicators when adopting the BSC model. However, they should also validate causal relationships between leading and lagging indicators periodically because the management environment changes constantly.

Delivery of Health Care↗
PubMedDate not supplied

Using a balanced scorecard to improve the performance of an emergency department.

The performance of the emergency department significantly improved after implementing the balanced scorecard including hours of continuing education attended by the staff, staff job satisfaction, the rate of incomplete laboratory tests within 30 minutes, the average monthly inappropriate return rate, and hospital profit. The results can assist administrators plan for the future. Although this was a pilot program for implementing a balanced scorecard in an emergency department, the indicators used in this study may also be reasonable for a hospital that has limited resources.

Adult↗