Payment and Emergency Medical Service in Central Taiwan

保險給付與緊急醫療服務：中台灣的經驗

陳維恭(Wei-Kung Chen) ； 黃正金(Jheng-Jing Hung) ； 鄭宜昌(Yi-Chang Cheng) ； 鍾侑庭(Yu-Ting Chung)

《Mid-Taiwan Journal of Medicine》 10卷2期 (2005/06) Pp. 99-106

https://doi.org/10.6558/MTJM.2005.10(2).7

摘要

Purpose Emergency medical care is a vital component of the public health and national health care systems. However, the management of emergency departments (EDs) tends to he more challenging than the management of other hospital departments. The aim of this study was to analyze the management strategies of EDs and to assess emergency medical services in terms of cost-based information so that these services can be better integrated and more effectively implemented.
Methods The data were collected from ED services in central Taiwan, and records showing physicians' fees and patients' payments in each ED were reviewed. Data on payments made by patients in the ED were obtained from reference data provided by Taiwan's National Health Research Institute. EDs' were classified as urban, suburban and rural according to location. Hospital levels were classified as medical center, regional hospital and local hospital based on accreditation by the Department of Health.
Results. The number of ED visits was significantly related to the population density (ED visits=1348 + 0.62×population density, p＜0.05). The distribution of patients' severity, physician manpower and patients' payment did not differ significantly between urban, suburban and rural EDs; however, these parameters varied significantly between different levels of EDs. Physician cost per patient was more than payment physicians received per patient from the National Health Institute, irrespective of hospital level.
Conclusions. EDs need to remodel their management strategies according to hospital level. Emergency departments in urban townships with fewer visitors had fewer demands of services; EDs in the same district should consider integrating. By adapting management strategies according to the population density in a township, integrated EDs will save money and he able to staff an adequate number of emergency physicians.

關鍵字

急診 ； 緊急醫療救護 ； 經營策略 ； 給付 ； 公共衛生

並列摘要

Purpose Emergency medical care is a vital component of the public health and national health care systems. However, the management of emergency departments (EDs) tends to he more challenging than the management of other hospital departments. The aim of this study was to analyze the management strategies of EDs and to assess emergency medical services in terms of cost-based information so that these services can be better integrated and more effectively implemented.
Methods The data were collected from ED services in central Taiwan, and records showing physicians' fees and patients' payments in each ED were reviewed. Data on payments made by patients in the ED were obtained from reference data provided by Taiwan's National Health Research Institute. EDs' were classified as urban, suburban and rural according to location. Hospital levels were classified as medical center, regional hospital and local hospital based on accreditation by the Department of Health.
Results. The number of ED visits was significantly related to the population density (ED visits=1348 + 0.62×population density, p＜0.05). The distribution of patients' severity, physician manpower and patients' payment did not differ significantly between urban, suburban and rural EDs; however, these parameters varied significantly between different levels of EDs. Physician cost per patient was more than payment physicians received per patient from the National Health Institute, irrespective of hospital level.
Conclusions. EDs need to remodel their management strategies according to hospital level. Emergency departments in urban townships with fewer visitors had fewer demands of services; EDs in the same district should consider integrating. By adapting management strategies according to the population density in a township, integrated EDs will save money and he able to staff an adequate number of emergency physicians.

並列關鍵字

emergency department ； emergency medical services ； management strategy ； payment ； public health