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

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

The risks of revisiting the ED within 3 days and readmission within 14 days significantly decreased after implementation of the GB system, which suggested that the quality of care was improved. However, after controlling other covariates, the GB was not associated with reduced risks of revisiting the ED within 3 days or readmission within 14 days. Furthermore, none of the tested variables were independent predictors of revisiting the ED within 3 days or being readmitted within 14 days for patients with unexplained fever. A possible reason this observation are the regulations for evaluating the quality of care in hospitals in Taiwan. BNHI has developed a series of plans structured to improve the quality of care while keeping costs under control. The plans offer incentives to health care providers by paying them based on clinical outcomes to care for overall wellbeing of patients. The risks of revisiting the ED within 3 days and readmission within 14 days are the two indicators used by BNHI to measure the quality of care. These two indicators are linked to the reimbursement rate at each hospital. The amount of reimbursement is reduced if the quality of care is determined to be poor. To safeguard against being penalized, all hospitals in Taiwan have made concerted efforts to reduce the 3-day ED revisiting and 14-day readmission rates. In this study, no difference in the risks of revisiting the ED within 3 days or readmission within 14 days between hospitals with different accreditation levels or between different geographic areas of Taiwan was noted.