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

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

This research has some limitations. First, the NHIRD data did not provide detailed information of patients regarding factors, such as their lifestyle, habits, socioeconomic status, and family history; all of which are possible confounding factors in this study. Second, the NHI claims registries are primarily used for administrative billing alone and thus are not verified for scientific purposes. The laboratory data and information regarding symptoms of patients were lacking, and therefore, discussion of these factors in relation to the GB system is not possible. Furthermore, because of the anonymity of the identification numbers, obtaining additional information by directly contacting the patients was not possible. The accuracy of medical coding in the claims data may affect the data validity. However, the diagnosis data in the NHIRD are highly reliable. The insurance system has mechanisms to monitor the insurance claims. Third, the conclusions derived from a cohort study are generally of lower methodological quality than those from randomized trials because a cohort study is subject to several biases and the necessary adjustments for confounding factors are required. Despite the meticulous design of this study and adequate control of confounding factors, biases associated with possibly unmeasured or unknown confounding factors can occur.