Biomedical subjects

Herng-Ching Lin

Publications and source records attributed to Herng-Ching Lin.

43 records · Page 3Linked to original sources

PubMed2004

Opinions of hospital administrators toward the prevalence of patient dumping in Taiwan.

BACKGROUND: The purposes of this paper were to examine whether patient dumping has occurred under the National Health Insurance and to explore hospital administrators' attitudes toward the practice of patient dumping in Taiwan. METHODS: The study subjects were administrators in general hospitals that were accredited by the Taiwan Joint Commission on Hospital Accreditation as medical centers, regional hospitals, or district teaching hospitals in the years 2000 and 2001. A self-administered postal survey was conducted using a structured questionnaire mailed to 128 administrators in general hospitals. RESULTS: Of the respondents, 83 of 99 (83.8%) administrators perceived that patient dumping did occur in their service areas to a certain degree regardless of their hospital location, hospital level, or hospital ownership. A total of 67 of 74 (90.5%) administrators who attempted to answer the question on the prevalence of patient dumping perceived that different percentages (mean=13.27%) of hospitals transferred patients solely on economic considerations in their service areas. In addition, this study found that no statistically significant relationships existed between the administrators' perceived percentage of emergency patients received by their hospitals and hospital characteristics. However, there was a statistically significant relationship between the perceived percentage of inpatients received and hospital level (p = 0.007). CONCLUSION: According to the results of this study, we concluded that patient dumping is a serious and widespread problem in the healthcare industry in Taiwan. Patient dumping can jeopardize patient health and impair the financial integrity of receiving hospitals. Implementation of a case payment system may worsened the situation in Taiwan.

Attitude of Health Personnel↗

PubMed2004

Do consumers in Taiwan need physician information?

BACKGROUND: This article was written to determine the extent of consumers' needs for physician information and what information consumers use in decision making when selecting a physician. METHODS: To collect data, a self-administered questionnaire was hand-delivered to 700 patients who visited the general surgery outpatient departments of seven hospitals during June 2003. A multiple logistic regression was conducted to identify the statistically significant factors related to patients' needs to use physician information. RESULTS: Of the respondents (N = 687), 74.7% felt they "greatly needed" or "needed" physician information. About 90% of respondents would "certainly" or "possibly" change physicians if the performances of their physicians shown by physician profiling were not as good as others. Respondents ranked the three most needed physician information as specialties, malpractice history, and overall patient satisfaction level. The multiple logistic regression showed that respondent's age, hospital level, personal monthly income, and whether they had compared medical care quality provided by neighborhood physicians had significant relationships with the respondent's needs for physician information after adjusting for other factors. CONCLUSIONS: This study found that 88.1% of respondents were in need of some amount of physician information. This is in light of calls for physician profiling from consumer-oriented organizations to assist consumers in selecting suitable physicians. It is recommended that the healthcare industry in Taiwan make a significant investment in a physician profiling system. The performance measures of this physician profiling system should be developed based on inputs from consumers, physicians, insurance companies, and researchers in this field.

Adolescent↗

PubMed2003

Factors related to dissatisfaction with the National Health Insurance among primary care physicians in Taiwan.

BACKGROUND: Few studies were found that evaluated dissatisfaction with the National Health Insurance (NHI) by primary care physicians in Taiwan. Therefore, the purpose of this study was to identify factors related to dissatisfaction with the NHI among primary care physicians. METHODS: A structured questionnaire was developed through a literature review, a panel discussion, and 5 focus group interviews. In total, 9336 primary care physicians were surveyed. A logistic regression analysis was employed to identify factors related to dissatisfaction with the NHI by primary care physicians. RESULTS: There were 1822 surveys returned, yielding a 19.5% response rate. They showed that 5.7% of respondents were very dissatisfied and 22.3% were dissatisfied with the current medical environment under the NHI. The dissatisfaction of primary care physicians was significantly related to age (OR = 1.029, p<0.05) and dissatisfaction with the following aspects: malpractice claims (OR = 1.744, p<0.001), complexity of medical claims (OR = 1.454, p<0.01), excessive work hours (OR = 1.790, p<0.001), decreased income (OR = 2.812, p<0.001), difficulty in finding nurses (OR = 1.379, p<0.05), and the separation of dispensing medicine from medical practice (OR = 1.389, p<0.05). CONCLUSIONS: These results can provide valuable information to help policy makers identify areas for improvement and intervention in order to reduce levels of dissatisfaction of primary care physicians under the NHI.

Adult↗

PubMed2003

Relationships between length of stay and hospital characteristics under the case-payment system in Taiwan: using data for vaginal delivery patients.

BACKGROUND: Case payment has been implemented since the beginning of Taiwan's National Health Insurance Program in 1995. This study selected patients undergoing a vaginal delivery to explore the relationships between maternal length of stay (LOS) and hospital characteristics under the case-payment system in Taiwan. METHODS: The National Health Insurance Research Database of 1999 from Taiwan's National Health Research Institutes was used in this study. In total, 5456 patients who underwent a vaginal delivery in 1999 meeting the selection criteria were drawn from the database. A multiple regression analysis was performed in which LOS was regressed against the variables of hospital level, hospital location, hospital ownership, and teaching status. RESULTS: The regression model indicated that hospital level, hospital ownership, and hospital location were significantly related to LOS after adjustment for patient age, principal procedure, and the presence of a secondary diagnosis. The LOS for patients undergoing a vaginal delivery in private hospitals was shorter than those in public and non-profit proprietary hospitals. Patients admitted to medical centers or regional hospitals were more likely to have a longer mean LOS in comparison with their counterparts admitted to district hospitals. The LOS for patients hospitalized in northern Taiwan tended to be significantly longer on average than those in central and southern Taiwan. CONCLUSIONS: This study demonstrates that wide variations in LOS exist among hospitals in Taiwan under the case-payment system. It is recommended that the Bureau of the National Health Insurance develop a national system to monitor certain hospitals that have an unusually short LOS.

Adolescent↗

PubMed2003

Exploring willingness and related factors by using the healthcare report cards for hospitals in Taiwan.

BACKGROUND: During the past decade, there has been growing a trend to develop and disseminate report cards to the public in the healthcare industries of the United States. The purposes of this article were to understand the willingness of hospitals in Taiwan to use report cards and to explore the factors that influence the willingness of hospitals to use them. METHODS: A postal survey study was conducted on 495 hospitals to explore factors influencing the willingness of hospitals to use report cards. A multiple logistic regression was performed to identify statistically significant factors related to the willingness of the hospitals to use report cards. RESULTS: In total, 52.0% of the sampled hospitals were "very willing" or "willing" to use report cards. The top three factors which respondents felt most influenced the willingness of hospitals to use report cards were the provision for incorrect data, the upgrading of the image of the hospital, and the increase in administrative costs. Multiple logistic regression analysis revealed that the willingness of hospitals to use report cards was positively significantly associated with the score of the factor "to upgrade the image of the hospital" (OR = 8.0; 95% CI 1.8-36.0), and it was negatively associated with the score of the factor "to increase the possibility of malpractice suits" (OR = 0.5; 95% CI 0.2-0.9). CONCLUSIONS: It was also found that more than half of hospitals were willing to use report cards. Thus, it is recommended that mandatory hospital report cards be initiated in order to allow consumers to make fair and accurate comparisons among hospitals.

Delivery of Health Care↗

PubMedDate not supplied

Physician supply, supplier-induced demand and competition: empirical evidence from a single-payer system.

We examined the earnings of 8106 office-based (FTE) physicians in 2002 in Taiwan for evidence of supplier-induced demand (SID). We hypothesize that SID, operating in the form of mutual cross-specialty referral, will cause earnings to increase with total physician density (all specialties taken together), but simultaneously, decrease with increasing competition within specialties. We used multiple regression analyses controlling for high-user population, physician demographics and practice type. The evidence supports our hypotheses. Increasing total physician density (all specialties) is positively associated with earnings. Concurrently, within specialties, increased competition is associated with reduced earnings. The medical appropriateness of increasing health care utilization with increasing physician supply cannot be directly determined from the data. However, evidence of a steady earnings increase with increasing total physician density, which precludes a saturation point (of appropriate care levels) at some optimum physician density, substantiates SID in the office-based practice market. Empirically, our data suggest that the average market effect of physicians on one another is synergic when all specialties are considered together, but competitive within each specialty.

Adult↗

PubMedDate not supplied

Reducing the numbers of the uninsured: policy implications from state-level data analysis.

The objective of the study described in this article was to identify a model that best predicts state uninsurance rates and quantifies the contribution of socio-economic factors to enable targeted state programs to reduce uninsurance. Linear regression analysis was carried out using state uninsurance rate as the dependent variable and state-level data on demographic, employment, income, and health care environment data (independent variables). For 2000 data, the model R is 0.77, indicating that 77% of the variation in uninsurance rates is explained by the percentage of immigrant population, the workforce in very small businesses, the Black population, the state's median income, and the Medicare-aged population (model R = 0.77 for 1999 and 0.68 for 1998 data). A 1% increase in immigrant population is associated with 0.18% increase in uninsurance rate. A 1% increase in workforce employed in very small businesses associates with 0.79% increase in uninsurance. The findings indicate substantial potential for reducing uninsurance through targeted state policies. Policy recommendations are made to alleviate the insurance hurdles faced by immigrant and small business employee populations.

Emigration and Immigration↗