The impact of global budgeting in Taiwan on inpatients with unexplained fever

Liu, Keh-Sen; Yu, Tsung-Fu; Wu, Hsing-Ju; Lin, Chun-Yi

[16] [17] [18] [19] [20] [21] A comprehensive and careful history-taking as well as examination by physician and exhaustive laboratory testing have are required for a focused diagnostic evaluation of FUO. [4] The diagnostic approaches for FUO include medical historytaking, physical examination, laboratory tests, and imaging studies. The etiologies of fever may be approached in terms of their height, fever pattern, and duration. Most studies have stressed on the significance of a complete history and comprehensive physical examination. In case of infectious FUO, fever is often accompanied by chills, night sweating, weight loss without loss of appetite, rigors, exudative tonsillitis, or splenomegaly. In general, the longer the FUO remains undiagnosed, the more likely it is to have a noninfectious etiology. [22] A patient presenting with B-symptoms and significant weight loss might have a neoplasm or malignancy as the cause of the FUO. By contrast, joint involvement may indicate rheumatologic disorders. [10, 23] Laboratory testing includes complete blood count, three sets of blood cultures, erythrocyte sedimentation rate, complete metabolic panel, urinalysis, urine culture, tuberculin skin test, and tests for biomarkers (such as antinuclear antibodies, rheumatoid factor, CMV immunoglobulin M, HIV antibodies, and heterophile antibodies) in children and young adults. Moreover, imaging techniques include chest radiography, computed tomography (CT), and radionuclide scanning. [24] FUO is associated with broad differential diagnosis leading to a wide range of potential diagnostic and therapeutic costs. However, little is known regarding the hospitalization costs for patients with FUO. Recent studies have reported high hospitalization charges for FUO (US$25,000-US$180,000). [25, 26] The National Health Insurance (NHI) program, the backbone of the health care system in Taiwan, is the major source of health financing and covers 99% of the population of Taiwan. National health care expenditure in Taiwan increased from 5.3% in 1995 to 6.0% in 2001 of the gross national product. The NHI operated on a fee-for-service (FFS) basis and as a result health care spending increased by approximately 50% from 1995 to 2001. To prevent unlimited and rapid growth of spending on health care, the Bureau of NHI (BNHI) implemented the global budget (GB) system to modify the FFS mechanism in 2002. The GB in Taiwan is an overall spending target, designed to limit the volume of service and its total price. [27] [28] [29] [30] [31] Here, we evaluated the differences in health service utilization, health care expenditures, and quality of care among patients with unexplained fever before and after GB system implementation by using NHI Research Database (NHIRD) data.