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

Assessing the impact of COVID-19 on outpatient and inpatient revenues: A comparative analysis of large and small hospitals in Taiwan

BACKGROUND

The COVID-19 pandemic has had profound effects on healthcare systems worldwide, not only by straining medical resources but also by significantly impacting hospital revenues. These economic repercussions have varied across different hospital departments and facility sizes. This study posits that outpatient (OPD) revenues experienced greater reductions than inpatient (IPD) revenues and that the financial impact was more profound in larger hospitals than in smaller hospitals.

METHODS

We collected data on patient case numbers and associated revenues for 468 hospitals from the Taiwan government-run National Health Insurance Administration website. We then employed Microsoft Excel to construct scatter plots using the trigonometric function (=DEGREES (Atan (growth rate))) for each hospital. Our analysis scrutinized 4 areas: the case numbers and the revenues (represented by medical fees) submitted to the Taiwan government-run National Health Insurance Administration in both March and April of 2019 and 2020 for OPD and IPD departments. The validity of our hypotheses was established through correlation coefficients (CCs) and chi-square tests. Moreover, to visualize and substantiate the hypothesis under study, we utilized the Kano diagram. A higher CC indicates consistent counts and revenues between 2019 and 2020.

RESULTS

Our findings indicated a higher impact on OPDs, with CCs of 0.79 and 0.83, than on IPDs, which had CCs of 0.40 and 0.18. Across all hospital types, there was a consistent impact on OPDs (P = .14 and 0.46). However, a significant variance was observed in the impact on IPDs (P < .001), demonstrating that larger hospitals faced greater revenue losses than smaller facilities, especially in their inpatient departments.

CONCLUSION

The two hypotheses confirmed that the COVID-19 pandemic impacted outpatient departments more than inpatient departments. Larger hospitals in Taiwan faced greater financial challenges, especially in inpatient sectors, underscoring the pandemic's varied economic effects. The COVID-19 pandemic disproportionately affected outpatient departments and larger hospitals in Taiwan. Policymakers must prioritize support for these areas to ensure healthcare resilience in future epidemics. The research approach used in this study can be utilized as a model for similar research in other countries affected by COVID-19.

The Response of Different-Levels Public Hospitals to Regional Global Budget with a Floating Payment System: Evidence from China

BACKGROUND

Regional Global Budget with a Floating Payment System (RGB-FPS) is a global budget widely used in medical insurance payments. However, existing studies on hospitals' responses to RGB-FPS have limitations. First, existing studies have paid little attention to RGB-FPS's macro effects. Theoretical studies did not analyze differences between different levels of hospitals. Secondly, studies did not reveal whether RGB-FPS has the same impact on the public-hospital-dominated market.

METHODS

First, we refine the research hypotheses through theoretical analysis. We then test the hypotheses empirically through interrupted time series analysis.

RESULTS

Theoretical analysis found that small hospitals were easier to transfer costs. The empirical analysis found that after RGB-FPS, the proportion of inpatients (PI)and the average times of inpatients in large hospitals increased (p < 0.001), and the proportion of non-reimbursable expenses (PNE) remained stable (p > 0.05). PI in secondary hospitals decreased (p < 0.01), and PNE increased (p < 0.01). PI in the primary hospital decreased (p < 0.05), and PNE increased (p < 0.001).

CONCLUSION

This study verifies theoretically and empirically that large hospitals are easier to increase service volume and small hospitals are easier to transfer costs under the influence of RGB-FPS. Chinese public hospitals' response to RGB-FPS is similar to that of private hospitals.