|Abstract: ||Objective: According to Department of Health of Executive Yuan, the number of psychiatric outpatients in Taiwan had increased from 1,990,917 to 2,146,224 between 2007 and 2009. To improve medical care quality, the Department of Health launched a series of Pay-for-Performance programs. In 2010, the department also implemented the Schizophrenia Medical Care Benefits Improvement Program to joint medical benefits to medical quality. This study took a psychiatric special hospital at central Taiwan as an example to analyze the leverage of the Schizophrenia Medical Care Benefits Improvement Program and factors affecting psychiatric clinics’ medical utilization.|
Methods: The study subjects were 1,633 outpatients and inpatients of a hospital at central Taiwan, and they had joined the medical benefits improvement programs in 2010. The authors analyzed the study subjects’ 2009 – 2010 medical claims for clinical visits and hospital admission using SPSS 12.0. Besides conducting descriptive statistics, the author also carried out the paired t-test, the McNemar’s test for analyzing quality indicators, and linear regression analysis for examining factors affecting the psychiatric clinic’s medical utilization after the implementation of the medical benefits improvement program.
Results: There were more male subjects than female ones in this study, and the majority of the subjects were 40 – 60 years old with junior high or high school education. For the quality indicators, the average length of hospital stay and the number of inpatients both increased in the psychiatric emergency ward but decreased in the chronic ward. Results from the regression analysis suggest that after introducing the improvement program, there was an increased variation in the clinic’s medical utilization of patients with higher education. The authors consider that this benefits improvement program intervention is more effective for patients with higher education. It was also found from this study that medical utilization frequency of this psychiatric clinic varied less with longer medical history.
Suggestions: Presently, there are still some quality indicators that do not meet the evaluation criteria. The government should work on promoting the medical benefits improvement program, to disseminate more detailed information related to the medical benefits improvement program to hospitals and clinics, and to encourage hospitals and clinics to proactively participate in the medical benefits improvement program. If our medical providers can implement sturdy case management and keep track of patients’ medical conditions proactively, then the overall medical service quality for psychiatric patients will be elevated effectively.