Tesi sul tema "Behavioral health insurance"
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1
Dunlap, Laura J. Norton Edward C. "The relationship between health insurance characteristics and the use of behavioral health treatment services". Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2006. http://dc.lib.unc.edu/u?/etd,308.
Abstract (sommario):
Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2006.Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Administration, School of Public Health." Discipline: Health Policy and Administration; Department/School: Public Health.
2
Stein, Bradley D. "Drug and alcohol treatment services among privately insured individuals in managed behavioral health care". Santa Monica, CA : RAND, 2003. http://www.rand.org/publications/RGSD/RGSD170/RGSD170.pdf.
3
Leung, Yat (Gary) Hung. "Behavioral Health Disorders and the Quality of Diabetes Care: A Dissertation". eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/456.
Abstract (sommario):
Both diabetes and behavioral health disorders (mental and substance use disorders) are significant health issues in the United States. While previous studies have shown worse health outcomes in people with diabetes and co-occurring behavioral health disorders (BHDs) than those with diabetes alone, it is unclear whether the quality of diabetes care was poorer in the presence of co-occurring BHDs. Although previous research has observed a trend of positive outcomes in people with comprehensive diabetes care, there is a lack of evidence about whether that mode of care delivery can improve outcomes in people with co-occurring BHDs. Therefore, further studies are necessary.
Using a combined dataset from Medicare and Medicaid claims for Massachusetts residents, this study compared the quality of diabetes care (e.g., having at least 1 hemoglobin A1c test) and diabetes outcomes (e.g., eye complications) among Medicare and Medicaid beneficiaries with diabetes and co-occurring BHDs to those with diabetes alone in Massachusetts in 2005. The results showed a mixed picture on the relationships between BHDs and diabetes outcomes. While substance use disorders had adverse impact on adherence to quality measures (e.g., 20% less likely to attain full adherence, p0.05).
Findings from this dissertation research suggest that disparities exist in the quality of diabetes care and health outcomes between people with substance use disorders and those without. The mode of care delivery needs to be further examined so that interventions can be designed to improve the outcomes of people with diabetes.
4
Al-Shawairkh, Abdulkariem Suliman. "Perceptions of the Saudi Students attending American Universities towards the new Saudi Mandatory Cooperative Health Insurance Program (MCHIP)". VCU Scholars Compass, 2006. http://scholarscompass.vcu.edu/etd_retro/15.
Abstract (sommario):
Reduction in the price of oil in the mid-eighties forced the Saudi government to adopt new health policies in order to finance health services. On August 11, 1999, the Saudi government approved a new Mandatory Cooperative Health Insurance Program (MCHIP). This new health policy was enacted to replace the current policy of providing free health care. MCHIP is intended to reduce the financial burden on government by sharing the costs of health care with the public. This study had a dual purpose: to analyze the components of MCHIP program by comparing it with the American health system, and to investigate the perceptions of Saudi students attending American universities towards MCHIP program, based on the students' experiences with the American health care system.A multiple methods approach was used to conduct the study. A descriptive approach was employed to compare components of the MCHIP program with similar components of the American health care system. A survey method was used to investigate the perceptions of Saudi students attending American universities toward the new MCHIP program. Scales were constructed to measure the students' expectations of the MCHIP program with respect to cost, quality, and access of health care. Additional scales were used to measure the students' knowledge of the MCHIP program, knowledge of the American health system, and total health insurance knowledge. An electronic survey was posted on the VCU SERL Web page, and a link was e-mailed to 2210 Saudi students using a list provided by the Saudi Arabian Cultural Mission (SACM). The survey response rate was 40.6 percent.During the first phase of the research, the comparison to American health care identified areas in which the United States of America experience could be useful in promoting effective implementation of the MCHIP program in Saudi Arabia. In sum, the comparison indicated that the American health insurance model may not be an ideal approach for the Saudi health system. During the second phase of the study, survey results indicated that students expected MCHIP implementation to increase total health costs, improve quality of health care, and increase access to health care in Saudi Arabia. The students' total knowledge of health insurance had a significant effect on students' perceptions of cost and a non-significant effect on their perceptions of quality and access to health care. In order for the MCHIP program to be effectively implemented, study results point to the need for regulation of the Saudi insurance market and for health insurance-related systems (such as for coding, billing, and maintaining effective medical records) to be established. American health insurance system models are not ideal for the Saudi health system, although certain aspects may be useful. To promote success, the MCHIP program should be structured to meet the goal of providing affordable and accessible quality health care to the population, based on Islamic principles.
5
Botkins, Elizbeth R. "Three Essays on the Economics of Food and Health Behavior". The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu149208205990797.
6
Rodriguez, Irene. "Factors That Influence Whether Mexican Americans With Depression Seek Treatment". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5588.
Abstract (sommario):
Mexican Americans, the largest Hispanic subgroup in the United States, tend to underuse mental health services. Grounded in Andersen's behavioral model of health services use, the purpose of this nonexperimental study was to examine the likelihood of birth country, education, income, and insurance predicting which respondents would report seeking mental health services to treat depression. The Mini International Neuropsychiatric Interview was used to diagnose depression in 203 Mexican Americans whose data was archived from the primary study. This archived data was analyzed within this study. The results of the 2 x 2 chi-square tests of independence indicated a significant association between a person's birth country and the likelihood that a person will seek mental health treatment, with U.S.-born participants more likely to seek mental health treatment than foreign-born participants. There were no significant bivariate associations found between education, income, or insurance and seeking mental health treatment. The full model containing the 4 independent variables was statistically significant per the results of the binary logistic regression analysis. This finding indicates that the model reliably distinguished between respondents who reported seeking and not seeking mental health treatment. The results of the binary logistic regression analysis indicated education was the only independent variable that made a uniquely significant contribution to the model, with participants with 12 years or more of education more likely to seek mental health treatment. The implications for positive social change include the potential to provide communities and health care providers knowledge of the factors that influence whether Mexican Americans with depression access mental health.
7
Bello, Nathalie Duque. "Balancing Act| Successfully Combining Creativity and Accountability in the Practice of Marriage and Family Therapy". Thesis, Nova Southeastern University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3721959.
Abstract (sommario):
The conditions that allowed early MFTs the freedom to creatively explore different interventions and theories of change are no longer available in today’s mental health care system. Although there are many benefits to the structure of managed behavioral healthcare organizations, a thorough review of the literature demonstrates that many therapists working in managed care agencies struggle with maintaining their theoretical creativity, claiming third-party payers’ service requirements and paperwork a barrier to their creativity. A phenomenological transcendental research method was utilized to understand the phenomenon of successfully combining creativity and accountability in the practice of marriage and family therapy from the perspective of six creative MFTs who have effectively incorporated creative therapeutic techniques into their work, while adhering to the structured requirements of managed care.
The findings and themes of the study were organized into two categories. The themes in the Textural / Content Category (description and purpose of therapeutic creativity at a managed care agency) are: (1) Creatively combining the needs of the clients, the different professional entities, insurance companies and you as a therapist, (2) Translating post-modern information into the medical model language that meets the third-party payers’ requirements, (3) Completing documentation with clients, (4) Incorporating technique from a range of therapy models, (5) Keeping clients engaged through a variety of resources and activities, and (6) Utilizing metaphors and themes to uncover patterns of relational dynamics and behaviors. The themes in the Structural / Supportive Conditions Category (factors that allow the balance of creativity and accountability to occur) are: (1) Systemic understanding of how the therapeutic and business systems of managed behavioral healthcare interact together, (2) Having a supportive network of colleagues, (2a) Supportive group of coworkers within the job setting, (2b) Supportive network of MFT colleagues outside of the work setting, (3) Desire to make a difference in peoples’ lives, (4) Continuous education on all aspects of the mental health field, (5) Employers’ support of creative therapy, (6) Self-reflection, (7) Self-care, and (8) Organization and time management.
8
Hill, Shelia Lassiter. "Reducing Health Disparities in African American Communities through Church and Federal Partnerships". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4636.
Abstract (sommario):
Despite the passage of the Patient Protection and Affordable Care Act (PPACA) in 2010, the Centers for Disease Control and Prevention identified persistent disparities in health care resources as the primary causes of mortality among minority populations. An underexplored resource for affected African American populations is the church, which is not a recognized stakeholder in the implementation of current health care policy. The purpose of this phenomenological case study was to gather perspectives from African American parishioners who lacked sufficient health care insurance on the roles the church could play. Qualitative data management software was used to organize the data (transcripts of interviews) for coding. The purposeful sample of 12 church attendees came from urban, suburban, and rural African American churches. The Andersen behavioral model and Hochbaum's health belief model were used as the conceptual framework for thematic analysis of health care disparities. Kingdon's multiple-stream framework provided theoretical grounds for policy development and revision. Key findings revealed several interrelated health care disparity themes: the significance of insurance coverages, premium costs, financial barriers, family and personal issues, empowerment strategies, religious beliefs, and roles the church could play in promoting quality community health. The study has implications for positive social change: The results include guidance for the development of a bipartisan health care policy that includes the church as a stakeholder. A- partnership between the church and the legislators of health care reform could be a catalyst for improved metrics, trust, accountability, transparency, and opportunities to create tailored health care interventions and thus help alleviate societal health crises.
9
Chevan, Julia. "Determinants of Care Seeking for Persons with Low Back and Neck Pain Treated By Physicians, Chiropractors or Physical Therapists". VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1469.
10
Redon, Margaux. "L'assurance santé privée à l'épreuve des objets connectés". Electronic Thesis or Diss., Rennes 1, 2021. http://www.theses.fr/2021REN1G017.
Abstract (sommario):
Le développement des objets connectés en santé/bien-être présente un potentiel de bouleversement de l’assurance santé privée, à l’instar d’autres secteurs de l’économie impactés par la numérisation. En effet, les objets connectés offrent techniquement diverses opportunités aux assureurs en santé : individualiser les risques, les segmenter plus finement, profiler pour passer à une logique prédictive, voire moduler les primes en fonction des décaissements anticipés par des informations reflétant le comportement, voire la santé de leurs utilisateurs. Ce potentiel technique ne peut toutefois pas être exploité pour changer le « logiciel » de l’activité d’assurance, en raison de la réglementation française, d’où un quasi-blocage du déploiement des objets connectés dans l’activité d’assurance santé privée sur un marché trop contraint pour intéresser les GAFA.Dès lors, les assurances privées en santé ont cherché à en valoriser l’utilisation dans leur relation avec l’assuré. Aux États-Unis, s’inscrivant dans le mouvement de santéisation, la responsabilisation des assurés a pu conduire à des prescriptions comportementales contrôlées par des objets connectés de santé/bien-être à la fiabilité et sécurité encore imparfaites. En France, cette logique de quantified self, pouvant aller jusqu’à l’observance de prescriptions comme condition de prise en charge, critiquable au regard des déterminants de santé et des inégalités sociales en santé, n’est que très peu explorée par les assureurs en raison d’un environnement juridique différent de celui des États-Unis dont l’un des objectifs est de protéger les personnes contre toute forme de discrimination à raison de leur état de santéThe development of connected objects in the health/wellness sector has the potential to revolutionize private health insurance, just like other sectors of the economy that have been impacted by digitalization. Indeed, connected objects technically offer various opportunities to health insurers: individualizing risks, segmenting them more acutely, profiling, resulting in a predictive logic, and even modulating premiums based on anticipated disbursements relying on information reflecting the behavior or even the health of their users. However, this technical potential cannot be exploited to change the "software" of the insurance business, due to French regulations. Thus, the deployment of connected objects in the private health insurance business is impeded in a market that is too constrained to appeal Gafa.Therefore, private health insurers have sought to enhance the use of connected objects in their relationship with policyholders. In the United States, as part of the so-called “healthism” movement, the accountability of policyholders has led to behavioral prescriptions controlled by connected health/wellness objects whose reliability and security are still imperfect. In France, this logic of quantified self, which can lead to compliance with prescriptions as a condition of coverage, is open to criticism with regard to health determinants and social inequalities in health. It is only very rarely explored by insurers because of a different legal environment from that of the United States, where one of the objectives is to protect individuals against any form of discrimination on the basis of their health status
11
Hsu, Minchung. "Essays on health insurance, saving behavior and the wealth distribution". Diss., Restricted to subscribing institutions, 2007. http://proquest.umi.com/pqdweb?did=1428847741&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
12
Boonyoung, Nongnut. "Health-seeking behaviors of Southern Thai middle-aged women by type of health insurance /". Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/7192.
13
Zeng, Han. "Three essays on consumer choice behavior in the health insurance market". [Bloomington, Ind.] : Indiana University, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3283963.
Abstract (sommario):
Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2007.Source: Dissertation Abstracts International, Volume: 68-10, Section: A, page: 4407. Advisers: Fwu-Ranq Chang; Tong Li. Title from dissertation home page (viewed May 20, 2008).
14
Tao, Betty T. Gilleskie Donna B. "The impact of health insurance on medical care, lifestyle behaviors and health of non-elderly diabetics". Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,1175.
Abstract (sommario):
Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Mar. 27, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Economics." Discipline: Economics; Department/School: Economics.
15
Dalaba, Maxwell Ayindenaba. "Impact of National Health Insurance on health seeking behavior in the Kassena-Nankana district of Northern Ghana". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/9391.
Abstract (sommario):
Includes bibliographical references.The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 with the aim of mobilizing additional funds for health care, promoting equal access to reasonable health care, pool health risks, prevent impoverishment, and improve the efficiency and quality of health care. The success of the NHIS in improving access to health care since its implementation and the extent to which it has impacted on health seeking behaviour has not been extensively investigated. This study examines health-seeking behaviours of insured and uninsured households on the mutual health insurance scheme on health care access in the Kassena-Nankana District (KND) of northern Ghana and to determine the factors that influence household decision to enrol into the NHIS. The study is a cross sectional survey of 422 household heads randomly selected to represent rural, peri-urban and urban zones of KND. Data was analysed using STATA version 8.0. A binary logit model was used to determine factors that predict household enrolment into the NHIS. The choice of a particular type of provider with multiple outcomes was analysed using a multinomial logit model. Results showed that 72% of household heads were males and the average age was 51 years. Out of the 422 respondents, 64% were insured. Household heads of age 40 years and above, being a female household head, being married, and economic wealth positively influenced enrolment into the national health insurance scheme. Seventy four percent (74%) of the ill among the insured and 48% among uninsured sought care from public facilities while 14% among the insured and 8% among uninsured sought care from private facility. Also, self treatment among the insured was 13% and 44% among uninsured households. Results also showed that being a member of NHIS and being moderately or severely ill were associated with public health facility utilization. Household heads of 60 years or older was negatively associated with use of public health facilities. Similarly, a household that was insured, being a Muslim and the severity of illness of household member were positively associated with the use of private health care. The findings showed that the insured were more likely to use formal care providers than the uninsured. This implies that the NHI in the KND has improved the health seeking behaviour from the hitherto use of informal providers and self treatment to preferred use of formal providers.
16
Morley, Erin. "Healthcare-seeking behaviors among Midwest farmers". Thesis, University of Iowa, 2019. https://ir.uiowa.edu/etd/6812.
Abstract (sommario):
The agriculture industry has high rates of injury and illness. Furthermore, the average age of US farmers is 58 years old. Chronic conditions are more common among older populations and often require management by a health professional. Farmers face barriers when seeking healthcare. These barriers include limited free time, shortage of providers in rural areas, limited funds, and poor health insurance. In addition, lack of quality health insurance and concerns about paying for healthcare are identified as barriers to healthcare-seeking behavior among farmers. More research is needed to examine the impact of type of health insurance on utilization of specific types of healthcare services among this high-risk population.
The goal of this study was to examine the association between a farmer’s type of health insurance and their healthcare-seeking behaviors. A brief, in-person, self-administered survey was used to identify the types of health insurance Midwest farmers were using and how this affected what type of healthcare services they utilized, specifically looking at preventive healthcare services. A second survey, administered online, was used to identify pre-existing conditions farmers had and the specific healthcare preventive healthcare services they utilized.
The online survey found that type of health insurance was significantly associated with usage of preventive services. Other associations were found in the in-person survey between type of health insurance and stress over health insurance as well as stress over injury on the farm. These results can be used to inform future health and safety programs about the impact of health insurance on farmer’s healthcare-seeking behavior. However, additional research should be done with a larger sample.
17
Ajam, Razaana. "The need for conflict management in organisations (a health insurance company, Port Elizabeth)". Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/3852.
Abstract (sommario):
Conflict is evident in many spheres of life, however this study concentrated more specifically on conflict relating to organisations. Organisational conflict is seen “as any social collectivity, organisations such as private sector companies, government departments, schools and universities, non-governmental organisations, and political parties all experience internal conflict in varying degrees” (Bradshaw, 2008: 22). Each individual coming into a workplace has created his or her own set of challenges especially in the brutal arena of business. Conflict has destructive and productive qualities that can diminish or elevate processes within an organization (Stone, 1999). If it is not harnessed properly or dealt with in the correct manner, it can damage the reputation of a business; resulting in its downfall and this in turn contaminates and affects peripheral businesses associated with the organisation downstream. This study explored the following key aspects: Background of organisational conflict and its management; Background of the organization; Whether these two areas mentioned above can work together to create a cost effective and efficient outcome when dealing with conflict. The research adopted a mixed method approach with predominant focus on qualitative research methodology. The main focus of this study was conflict management within organisations and to probe and determine whether companies see the need to employ the field of conflict management as a strategy in times of fluctuating dispositions. It is evident that the organisation may not be fully aware or make use of alternative conflict resolution strategies and that the main causes of conflict can be eliminated such as poor communication, ill-defined job descriptions and objectives and differing of opinions. The need to employ alternative methods of conflict management may be emphasised by looking at the costs that conflict produces and the use of limited vital resources and the loss of human capital.
18
Flodkvist, Evelina. "Gender roles and perceptions about improved Community-Based Health Insurance : A case study in Babati, Tanzania". Thesis, Södertörns högskola, Utveckling och internationellt samarbete, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-32696.
Abstract (sommario):
People´s access to safe health care is not as common as one might think. Today with new and different health insurances and improved health policies people should in theory have safe health care. Although numerous of health insurances exist, targeting large parts of populations, there are still many issues with them. The Behavioural Model of Health Services Use and Separate Spheres are the two theories that are used in this study. Where Separate Spheres describes men´s and women´s separate worlds, their responsibilities in them and how it effects them and the Behavioural Model of Health Services Use, which describes factors that either impede or enable people’s access to health care utilization. This study´s purpose is to see what different perceptions men and women have about the insurance and how these perceptions can affect families’ choice to enroll to the insurance. The study uses a qualitative approach and is based on semi-structured interviews. Results in this study showed that men and women have very different perceptions about the insurance. Men want the insurance because they want to save money and decrease health expenses. While women wants the insurance for their children to always have access to health care. The roles between men and women in households are significant and their different responsibilities affect their priorities and perceptions.
19
Park, Ju Moon Aday Lu Ann. "The determinants of physician and pharmacist utilization and equity of access under Korean universal health insurance /". See options below, 1994. http://proquest.umi.com/pqdweb?did=741485541&sid=1&Fmt=2&clientId=68716&RQT=309&VName=PQD.
20
Shang, Ze Zhong. "Individual behaviours when facing health risk and their aggregate impacts on the society". Thesis, Le Mans, 2019. http://www.theses.fr/2019LEMA2001/document.
Abstract (sommario):
La santé joue un rôle de plus en plus important dans l'économie dans les dernière années: d'une part, on observe une amélioration significative du niveau moyen de la durée de vie, d'autre part, il y a également une forte croissance sur les dépenses de santé. Dans cette thèse, on commence par présenter ces 2 faits stylisés mais on présente également que même s'il y a une amélioration du niveau moyen de la durée de vie, l'inégalité de la santé est toujours rapportée est en effet a tendance d'accroître, on présente aussi que les pays dont les dépenses de santé sont assez importantes en général n'ont pas un système de santé efficace. Par conséquence, cette amélioration de la santé humaine semble de bénéficier plus les gens qui peuvent payer le coût. Afin de trouver les raisons qui cause ce phénomène et proposer des solutions pratiques qui permet de résoudre ce problème, dans cette thèse, on prend 2 approches : premièrement, on commence par l'approche déterministe et également l'approche plus théorique, dans cette approche, on présente notre modèle basé sur le modèle du capital de santé du Grossman et on examine comment réagissent les agent face à la fluctuation de santé, puis on tourne vers le deuxième approche, qui est l'approche stochastique et également l'approche plus pratique, dans cette approche on utilise la chaîne de Markov pour simuler un vrai risque de santé et examine quelle seront les décisions d'agent de différents SES dans cette situation, on agrège ensuite ces décisions pour voir l’impact agrégé qui peuvent être généré sur l'ensemble de l'économie, finalement, on examine comment ces décision peuvent être affectées par des politiques publicsDuring the past 2 decades, health has become a more and more important role in our economy life: on the one hand, we observe a significant improvement of average lifespan across the globe, on the other hand, the health expenditures is also increasing enormously, which has become a shake to the public health system of many countries. In this dissertation, we begin with these 2 stylized facts but we also show that there is more to it: though the average level of health has been improved significantly, health related inequalities are still being reported and actually tend to increase, plus, we also show that countries with important health expenditures performs generally poorly in terms of health system efficiency, in short, this improvement of human health we are talking about seems to benefit more those who can pay the bills. In order to figure out what causes this phenomenon and eventually propose practical solutions that help solve the problem, in this dissertation we take 2 approaches: first we start with the deterministic approach and also the more theoretical approach, in this approach we build our model based on the Grossman health capital model and we examine how people would behave when their health fluctuates, then we turn to the second approach, which is the stochastic approach and also the more practical approach, in this approach we use the Markov chain to simulate the real health risk and examine the behaviors of individuals of different social-economic status(SES) under this circumstance, we also aggregate these behaviors to see what impact could be generated on the whole society and we test reversely how these behavior would affected by public policies
21
Godzinski, Alexandre. "Three empirical essays on moral hazard identification in insurance". Thesis, Paris, EHESS, 2017. http://www.theses.fr/2017EHES0106.
Abstract (sommario):
L’aléa moral est une source de distorsion économique. La prédiction classique dans un cadre simple est qu’une meilleure couverture conduit à un effort moindre. Cette thèse étudie dans quelle mesure cette prédiction est ou non vérifiée empiriquement dans des cadres plus complexes. Le premier chapitre s’intéresse aux absences pour raison de santé. La politique étudiée est le jour de carence pour arrêt maladie dans la fonction publique de l’Etat en France. Cette politique de remboursement moins généreuse a notamment pour but de réduire l’absentéisme. Elle conduit à une baisse de la prévalence des absences de courte durée. Mais elle conduit aussi à une hausse de la prévalence des absences de longue durée. En conséquence, la prévalence de l’ensemble des absences pour raison de santé reste inchangée. Les deux chapitres suivants s’intéressent aux systèmes de bonus-malus d’un assureur automobile irlandais. Le deuxième chapitre s’intéresse à l’introduction d’un état très protecteur : la protection à vie du bonus. Cette protection est octroyée automatiquement et gratuitement aux assurés sous des conditions restrictives d’historique de sinistre et d’ancienneté. Comparé à la situation dans laquelle cet état protecteur n’existe pas, le taux de sinistre des assurés protégés augmente, tandis que le taux de sinistre des agents non protégés diminue, dans l’espoir d’être récompensés par la protection. L’existence de la protection est à l’origine d’un transfert intertemporel. Les assurés renoncent à de l’utilité présente en exerçant un effort supérieur, afin d’être récompensés par la protection et de profiter d’une utilité future plus élevée due à un effort moindre. Le troisième chapitre étudie la réaction juste après que l’assuré est récompensé par la protection à vie du bonus. Le taux de sinistre augmente immédiatement, mais seulement quand la protection existe depuis quelque temps. Cela suggère que l'effet d'un changement incitatif dépend de sa nature, mais aussi de son contexteMoral hazard is a source of economic distortion. The classical prediction in a simple framework is that a better coverage leads to a lower effort. This thesis studies the extent to which this prediction is empirically verified in more complex settings. The first chapter focuses on health-related absences. The policy under study is the one-day waiting period for sick leave in the French central civil service. This less generous reimbursement policy notably aims at reducing absenteeism. It leads to a decrease in the prevalence of short-term absences. But it also leads to an increase in the prevalence of long-term absences. As a result, the prevalence of all health-related absences stay unchanged. The two following chapters focus on bonus-malus systems used by an Irish car insurer. The second chapter focuses of the introduction on a highly protecting state: the lifetime bonus protection. This protection is granted automatically and freely to insurees under restrictive conditions on past claims and seniority. Compared to the situation in which this protecting state does not exist, the claims rate of protected insurees increases, but the claims rate of unprotected insurees decreases, in the hope of being rewarded with the protection. The existence of the protection induces an intertemporal transfer. Insurees waive present utility by exerting more effort, so as to be rewarded with the protection and to enjoy more future utility due to lower future effort. The third chapter studies the reaction just after the insuree is rewarded with the lifetime bonus protection. The claims rate increases immediately, but only when the protection exists for some time. This suggests that the effect of an incentive change depends on its nature, but also on its context
22
Miller, Vail Marie. "The Role of Consumers in the Success of the Consumer Driven Healthcare Movement". Cleveland, Ohio : Case Western Reserve University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1259787032.
Abstract (sommario):
Thesis(Ph.D.)--Case Western Reserve University, 2010Title from PDF (viewed on 2010-01-28) Department of Bioethics Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center
23
Huang, Wei. "Consumer perceptions and health insurance decisions". Thesis, 2015. https://hdl.handle.net/2144/13292.
Abstract (sommario):
Numerous studies have shown that consumers react imperfectly to changes in health insurance coverage. To justify consumer valuation in health insurance decision-making, I use Medical Expenditure Panel Survey (MEPS) data and conduct three studies to examine consumer’s private information in health insurance decision-making under a conceptual framework of consumer perception, which potentially is informative about Affordable Care Act (ACA) Health Insurance Marketplace consumer behavior.
In the first study, I examine the joint role of individual preferences and health risk in two types of insurance decision-making: the probability of being insured and the probability of employment-based insurance if insured. Using logistic regression, I find that the healthier and wealthier consumers tend to have more positive attitudes towards health insurance and thus are more likely to be insured. The effects of health risk measures vary largely in insurance decisions conditional on different preference measures and preference levels.
In the second study, I investigate insurance coverage bundle choices with multi-dimensional private information in an artificially created market setting. I adapt the approach developed by Lokshin and Ravallion (2005) and conduct logistic regression modeling to estimate the reduced forms for coverage bundle choice and consumer attitude respectively. Predicted linear indices for consumer attitude and coverage bundle choices are calculated separately, then their correlation coefficients are compared. In this study I find that consumer attitude plays a dominating role in health insurance decision-making, suggesting that risk preferences may internalize health risks and influence insurance purchasing decisions.
To further explore consumer perceptions within an individual’s personal system of decision rules, in the third study, I construct coverage bundle choices in an order from the least complete to the most complete, and examine the effect of consumer perceived plan quality to coverage bundle choice decisions. I use the generalized ordered logit method and a Bayesian learning process for the analysis. I find that coverage bundle choice decisions are value-based, for which perceived plan quality plays a significant and persistent role.
The study results also have important policy implications to enhancing consumer engagement and optimizing health insurance management to provide high quality care to health insurance beneficiaries.
24
Shi, Ju. "Behavioral response, plan sorting, and financial protection in health insurance markets". Thesis, 2013. https://hdl.handle.net/2144/13127.
Abstract (sommario):
In both developed and developing countries, it is important to know about consumer behavior in the health insurance market. The first essay analyzes the behavioral response to income cutoffs of a subsidized health insurance program in the Massachusetts reform. Subsidies in the program are based on household income and have explicit income cutoffs. This feature creates nonlinear budget constraints for households' consumption, and potentially distorts their income and labor supply. I test the existence of income manipulation using the regression discontinuity approach on data from the American Community Survey. I find clear evidence of income discontinuity around the cutoffs of 150% and 300% of the Federal Poverty Level. I construct a structural model to estimate the elasticity of labor supply with respect to wage rates using the discontinuity evidence, suggest a methodology to calculate the welfare loss, and project the magnitude of behavioral response in the national health reform.
The second essay analyzes consumer choice of health insurance plans after U.S. health reform. In the new state-run "Health Insurance Exchanges" created as part of the Affordable Care Act, plans with different benefit coverage of health care costs are provided in order to expand consumer choices and increase consumer welfare. According to the Act, premiums can differ based on enrollees' characteristics and plan revenues are risk-adjusted by regulators who transfer revenue from low to high risk plans. This essay examines how risk adjustment and premium discrimination affect consumers' choices of plans theoretically and empirically. I find that under plausible conditions risk adjustment and premium discrimination encourage consumers to enroll in plans with high benefit coverage.
The third essay studies how a new Chinese rural health insurance program affects adverse selection and impacts enrollees' out-of-pocket costs. Using a national four-year panel dataset to address households' participating behavior and the impact of the plan, I show that adverse selection was not severe at household level, and the impact of the program on reducing out-of-pocket expense is greater for the rich than that for the poor, although on average was not statistically significant.
25
HUANG, YUN-TING, e 黃筠婷. "The Impact of Basic Outpatient Copayment of National Health Insurance to Health-seeking Behavior by Using the Behavioral Theories". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/sj3jcx.
Abstract (sommario):
碩士國立臺北護理健康大學
健康事業管理研究所
105
Background: Copayment is an important part of the infrastructure of Taiwan’s national health insurance system. The purpose is to establish a sound referral system and to improve the quality of the departmentalized medical services in hospitals. The modification/rewrite of the legislation by the authority is meant to monitor how medical resources are utilized. However, since 2005 the cost of the outpatient copay has not been raised for almost 10 years. Unlike most of the western countries where there are stricter referral systems, the Taiwanese have more freedom to choose the medical services they desire; as a result, the large medical institutes are flooded with patients of minor issues. This specific and unique situation has complicated the implementation of hierarchical health-seeking behavior. There are many studies using contingent valuation methods to investigate the amount people willing to pay, and behavioral theory to predict health-seeking behavior. There are also past literature using behavioral theory to predict medical behavior, but there is no literature for graded medical treatment for further study. Purpose: The purpose of this study: 1) identify what the reasonable amount of outpatient copayment is that people are willing to pay for the implementation of the hierarchical medical system; 2) compare Theory of Reasoned Action (TRA) with Theory of Planned Behavior (TPB) to find out which one is more feasible in predicting people’s hierarchical health-seeking behavior; 3) assess the intention to pay and the willingness to pay in both behavior theories to figure out predictability model. Method: In this study sampled population was the patients from a certain academic medical research center in Taiwan. Data were collected by 1,134 distributed questionnaires with 971 returned. The response rate was 85.63%. Data analyses include sample description analysis, t-test, and analysis of variance. The program used to analyze data is Structural Equation Modeling (SEM) using SPSS 22.0 and AMOS 19.0. Data analysis will be used to explore TPB and TRA and determine which is more feasible for people’s health-seeking behavior. Result: The average WTP of the outpatient co-payment for academic medical centers amounted to NT$443.59. In order to implement the hierarchical health seeking behavior the average value of the "attitude" score was 5.47, and the influencing factors included age, educational level, self-conscious health status and chronic disease ; In order to implement the hierarchical health seeking behavior the average value of the "subjective norm" score was 4.32, and the influencing factors included age, education level, marriage, self-health and chronic disease; In order to implement the hierarchical health seeking behavior the average value of the "perceived behavioural control" score was 4.85, and the influencing factors included gender, marriage, self-health and monthly income; In order to implement the hierarchical health seeking behavior the average value of the "behavior" score was 4.52 points. The influencing factors included age and chronic disease. The Theory of planned behavior was found to be better than the theory of reasoned action in predicting people’s health-seeking behavior. In addition, the willingness to pay was a stronger prediction factor compared to the intention for people’s health-seeking behavior. Suggestions: In the past most of the studies used intentions to explain patients’ behavior. In this study in terms of academics it is imperative to be able to predict the perceived behavioral control that provides a theoretical insight for the health-seeking behavior. Based on the results of this study, the author found that the willingness to pay is more effective in predicting factors of health-seeking behavior. In facing the reality of the national health insurance system, the government raised outpatient copayment to NT$420 on April 15, 2017. The amount mandated by the government is still lower than the amount that people are willing to pay out of their own pockets. This study is made available for any government agency to review for future policy development including revision of the amount of the outpatient copay.
26
WANG, YI-KUEN, e 王一焜. "A Study on Online-Applicant Behavioral Intention of Supplementary Premium in Health Insurance Units". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/26813878394832378031.
Abstract (sommario):
碩士銘傳大學
公共事務學系碩士在職專班
105
The National Health Insurance Administration in order to enhance the quality of citizen services, promoting e-government policy, accelerate the pace of informationization, the use of electronic credentials to apply supplementary health insurance premium details online. Deduction obligation to accept online applicant system of supplementary health insurance premium details is the first step to achieve the electronic network applicant and more successful online applicant system is based on the deduction obligations by the willing and sustainable use. This research to health insurance deduction obligations research object, UTAUT and join the trust, exploring the concept of cognitive risk, analysis supplementary health insurance premium deduction obligations for online applicant supplementary health insurance premiums deduction detail behavior using the will and use different for the theoretical framework to be used by the network questionnaire for investigation and analysis of statistical methods for the empirical study. The research findings confirmed to online applicant health insurance supplementary premium details the "performance expectancy" and "social influence" two factors affect a significant positive impact on the use intention of online applicant supplementary premium details and the "cognitive risk" for actual adopters will significantly affect the behavior of the positive will to apply supplementary premium details, network service satisfaction up to 77.8 percent, showing a online applicant quite acceptable for apply supplementary health insurance premiums network service in 32.4% actual electronic certificate applicant. It is recommended that the National Health Insurance Administration can use health insurance mobile APP combined with binding cell phones and one-time password as the user identity authentication, and let the deduction obligations increase the trust of the network applicant, thereby enhancing willingness to use online applicant supplementary premium details.
27
Chen, Tianxu. "Health insurance coverage and personal behavior". Thesis, 2014. https://hdl.handle.net/2144/15137.
Abstract (sommario):
Subsidies, taxes, premiums, and eligibility for health insurance can potentially cause "marriage lock," in which couples stay married for the sake of health insurance coverage, and marriage lock may change under the Affordable Care Act. In the first two chapters, marriage lock is examined in the context of two key health insurance decisions: divorce decisions upon qualification for Medicare at age 65, and marriage and divorce decisions associated with the introduction of the Massachusetts insurance mandate and health insurance exchange market reforms in 2006. In the first chapter, using the Health and Retirement Study data, I find evidence of a 7 percentage point increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. In the second chapter, using the American Community Survey data, I find that the 2006 Massachusetts healthcare reform increased incentives for marriage in the health insurance exchange market relative to control states. Specifically, the Massachusetts reform appears to have reduced the divorce rate by 0.5 percentage point and increased marriage rate by 1.4 percentage points.
In the third chapter, I use data from the China Household Finance Survey (CHFS) to explore three decisions potentially affected by the implementation of Medical Savings Accounts (MSAs). First, I find that individuals with MSAs incur 17 RMB more medical expenses per 1000 RMB increase in their MSAs balance, while I find no significant effect of after-tax income on medical expenses. Second, I study preference heterogeneity as revealed by three types of risky behaviors. I find undertaking risky investments is associated with 23% more medical expenditures, while always using a seatbelt and obeying traffic signals are associated with 16% and 22% higher medical expenditures, respectively. Finally, I find evidence suggesting that individuals become more risk adverse with MSAs than without, specifically by increasing their use of seatbelts and obeying traffic signals. These findings, using recent Chinese data, suggest that MSAs play an important role when consumers make health expenditure decisions, and that preferences involving risk and prevention also appear to be influenced by the MSA scheme.
28
Yeh-Hsiang-Chi e 葉湘琦. "Sales Health Insurance Behavior Research by Salesperson in Property Insurance Company". Thesis, 2007. http://ndltd.ncl.edu.tw/handle/07973581865429471698.
Abstract (sommario):
碩士樹德科技大學
金融保險研究所
95
Health insurance embraces the dual natures of personal insurance and property insurance. Health insurance in Taiwan was before categorized under the business of life insurance; however, after the legislative assemblies approved of property insurance industry operating health insurance with a term less than one year, another sales channel for the latter has been found and applied. In addition, during the process when a business is propelled, “people” become the key factors to be considered. For this reason, the intentions of the salespersons working at property and casualty insurance companies to sell health insurance are worth a discussion. Applying decomposed theory of planned behavior, this research combines the self-efficacy of planned behavior theory and social cognitive theory to discuss how self-interest, obstacles, important others, external environment, self-efficacy, favorable conditions, past experience and so forth affect the intentions of the salespersons in property and casualty insurance companies to promote health insurance. With questionnaire survey method, this research takes the salespersons from 15 domestic property and casualty insurance companies and 8 foreign property and casualty insurance companies, 23 companies in total, as the sampling frame and acquires 480 valid questionnaires. The results reveal that the sales intentions of the salespersons in property and casualty insurance companies are affected by self-interest, important others, self efficacy as well as past experience. Besides, the past experience of the salespersons and important others also influence their intentions to sell health insurance by the intermediary effect of self-interest and self-efficacy.
29
Maggi, Piero. "Enhanced web analytics for health insurance". Master's thesis, 2020. http://hdl.handle.net/10362/101010.
Abstract (sommario):
Internship Report presented as the partial requirement for obtaining a Master's degree in Data Science and Advanced AnalyticsNowadays companies need invest and improve on data solution implementation within most of the business workflows and processes, in order to differentiate the offer and stay ahead of their competitors. It’s becoming more and more important to take data driven decisions to boost profitability and improve the overall customer experience. In this way, strategies are defined not anymore on common beliefs and assumptions, but on contextualized and trustful insights. This reports describes the work that has been made during a 9-month internship, in order to provide the business with a new and improved solution for enhancing the web analytics tasks and supporting the improve of the online user digital experience. User-level data related to the website activity has been extracted at the highest granularity level. Afterwards, raw data have been cleaned and stored in an Analytical Base Table with which an initial data exploration has been made. After giving initial insights to the digital team, a predictive model has been developed in order to predict the probability of the users to buy the insurance product online. Finally, based on the initial data exploration and the model’s results, a set of recommendations has been built and provided to the digital department for their implementation in order to make the website more engaging and dynamic.
30
(9073700), Svetlana N. Beilfuss. "Essays on Patient Health Insurance Choice and Physician Prescribing Behavior". Thesis, 2020.
Abstract (sommario):
This dissertation consists of three chapters. The first chapter, Inertia and Switching in Health Insurance Plans, seeks to examine health insurance choice of families and individuals employed by a large Midwestern public university during the years 2012-2016. A growing number of studies indicate that consumers do not understand the basics of health insurance, make inefficient plan choices, and may hesitate to switch plans even when it is optimal to do so. In this study, I identify what are later defined as unanticipated, exogenous health shocks in the health insurance claims data, in order to examine their effect on families' plan choice and switching behavior. Observing switches into relatively generous plans after a shock is indicative of adverse selection. Adverse retention and inertia, on the other hand, may be present if people remain in the relatively less generous plans after experiencing a shock. The results could help inform the policy-makers about consumer cost-effectiveness in plan choice over time.
Physicians’ relationships with the pharmaceutical industry have recently come under public scrutiny, particularly in the context of opioid drug prescribing. The second chapter, Pharmaceutical Opioid Marketing and Physician Prescribing Behavior, examines the effect of doctor-industry marketing interactions on subsequent prescribing patterns of opioids using linked Medicare Part D and Open Payments data for the years 2014-2017. Results indicate that both the number and the dollar value of marketing visits increase physicians’ patented opioid claims. Furthermore, direct-to-physician marketing of safer abuse-deterrent formulations of opioids is the primary driver of positive and persistent spillovers on the prescribing of less safe generic opioids - a result that may be driven by insurance coverage policies. These findings suggest that pharmaceutical marketing efforts may have unintended public health implications.
The third chapter, Accountable Care Organizations and Physician Antibiotic Prescribing Behavior, examines the effects of Accountable Care Organizations (ACOs). Physician accountable care organization affiliation has been found to reduce cost and improve quality across metrics that are directly measured by the ACO shared savings program. However, little is known about potential spillover effects from this program onto non-measured physician behavior such as antibiotic over-prescribing. Using a two-part structural selection model that accounts for selection into treatment (ACO group), and non-treatment (control group), this chapter compares physician/nurse antibiotic prescribing across these groups with adjustment for geographic, physician, patient and institutional characteristics. Heterogeneous treatment responses across specialties are also estimated. The findings indicate that ACO affiliation helps reduce antibiotic prescribing by 23.9 prescriptions (about 19.4 percent) per year. The treatment effects are found to vary with specialty with internal medicine physicians experiencing an average decrease of 19 percent, family and general practice physicians a decrease of 16 percent, and nurse practitioners a reduction of 12.5 percent in their antibiotic prescribing per year. In terms of selection into treatment, the failure to account for selection on physician unobservable characteristics results in an understating of the average treatment effects. In assessing the impact of programs, such as the ACO Shared Savings Program, which act to augment how physicians interact with each other and their patients, it is important to account for spillover effects. As an example of such spillover effect - this study finds that ACO affiliation has had a measurable impact on physician antibiotic prescribing.
31
Chen, Shao-Tung, e 陳少東. "A study on the relationships among people’s knowledge and attitude to commercial insurance, behavior for health care utilization under National Health Insurance". Thesis, 2019. http://ndltd.ncl.edu.tw/handle/v3rbm5.
Abstract (sommario):
碩士國立中山大學
企業管理學系醫務管理碩士班
107
Background and Purpose: The national health insurance benefits is subject to more restrictions in the future and hence the public will emphasize more on commercial health insurance with higher medical quality and care. As commercial health insurance becomes widely available, the study intends to investigate the correlation between the knowledge on commercial health insurance, attitude, and healthcare utilization behavior in people. Method: The design of the study questionnaire takes reference from the KAB MODEL by Schwartz (1975), adopting structural questionnaire model for conducting the investigation. The study objects comprise people aged 20 years or older and the questionnaires were distributed via online questionnaire survey – DoSurvey. The duration of survey started in October 2018 and ended in December, 2018, with a total of 400 questionnaires recovered. The study adopts SPSS 19.0 as data analysis tool, applying descriptive statistics, independent sample t-test, one-way ANOVA, Pearson correlation analysis, and multiple regression analysis for data analysis. The study analyzes the correlation between public’s knowledge and attitude on commercial health insurance towards public behavior of healthcare utilization, under the national health insurance system. Results: The study probes into the factor of correlation influence on the knowledge, attitude and healthcare utilization behavior of commercial health insurance for the public with commercial health insurance through the theory of knowledge, attitude and behavior. The study findings reveal that the average score for knowledge on commercial medical insurance for the public living in Yilan, Hualian and Taitung is lower than that in New Taipei City, Taipei City and Keelung. Moreover, the average score for public with monthly dispensable amount of $20,001~$30,000 on commercial insurance is higher than the public with monthly dispensable amount of $5,000. The aspect of medical care seeking behavior in healthcare utilization behavior indicates that the average score for medical seeking behavior of students is higher than those in the service industries; the aspect of insurance utilization in healthcare utilization behavior suggests that married people have higher average score in insurance utilization than single people. Moreover, there is significance in medical seeking behavior and insurance utilization in healthcare utilization behavior, indicating that the medical seeking behavior for people with higher insurance utilization also relatively increases. It is inferred that people with commercial health insurance are subject to issues of ethical risks due to insurance utilization. Conclusion: The study findings reveal that commercial insurance is gradually drawing attention from the public while the demand for commercial health insurance also increases accordingly, as commercial health insurance becomes widely available. The public conducts risk sharing for health to reduce the uncertainty risk of personal health condition, which will avoid the burden associated with medical expenses in times of disease. Nonetheless, the issues of potential ethical risks concurrently arise from public’s utilization of commercial health insurance relative to the public’s healthcare utilization behavior.
32
Lee, Hung-Ming, e 李宏銘. "The associations between healthy behaviors and life medical insurances". Thesis, 2004. http://ndltd.ncl.edu.tw/handle/88482286450121429232.
Abstract (sommario):
碩士國立高雄第一科技大學
風險管理與保險所
92
Accompanied with increased life expectancy and escalated sale of life medical insurance, there is a sense that the hospitalization rate may increase. Owing to this increase and no claim limit to the life medical insurance, the insurance company may encounter enormous financial burden. The government, the industry and the academic are all aware of this heated issue. While medical technology is advanced, the length of hospitalization may be decreased. Because the premium for the life medical insurance is high, there are fewer cases with moral risk. If ill-health behaviours such as smoking, drinking and betel nuts consumption have impact on individuals’ willingness to purchase this life medical insurance, the insurance company may tend to select clients who are healthy and do not have negative habits in order to minimize the re-claim rate below the predicted amount. Therefore, the insurance company may be able to avoid any financial burden. The present study aimed to examine how individuals’ ill-health behaviour (i.e. smoking, drinking and betel nuts consumption) and life style (i.e. exercise frequency, social activity and outdoor activity) would associate with the willingness of individuals to buy life medical insurance. There is an underlying rationale to choose those ill-health behaviours as independent variables in the analysis. Once individuals addict to those ill-health behaviours, they would spend fixed amount of their income to satisfy these desires. Providing the same level of the income, those individuals who have ill-health habits may have less income left to spend. As a consequence, whether individuals have ill-health behaviours may influence their willingness to purchase the life medical insurance. The sample in the current study was selected from sanitary wokers because income difference is small among employees and they are more likely to possess unhealthy habits. Data had shown that whether individuals were smoking or consume betel nuts is significant associated with their willingness to purchase the medical insurance. In theory, this association may not be a direct relationship but more likely to be indirect relationship. In other words, those individuals who smoke and consume betel nuts may not purchase a medical insurance to avoid the risk of being ill. Giving the same level of income, those individuals who have smoking and betel nuts consumption habits may need to spend their income on these items, accordingly, their willingness to buy high-premium medical insurance may be lower than those people who do not have such negative habits.
33
WU, GUO-SHI, e 吳國士. "The effect of health insurance on the consumer behavior for medical care". Thesis, 1990. http://ndltd.ncl.edu.tw/handle/00409133502838325744.
34
Adonis, Leegale Franscesca. "Screening practices of a health insured population and the role of behavioural economics". Thesis, 2015. http://hdl.handle.net/10539/18672.
35
Chang, Jung-Chi, e 張羢琦. "Modeling Patient''s Behavior of Taking Medical Treatment under National Health Insurance System". Thesis, 2005. http://ndltd.ncl.edu.tw/handle/387czw.
Abstract (sommario):
碩士國立臺北科技大學
商業自動化與管理研究所
93
Since the national health insurance was enforced in 1995, we found that the medical treatment costs continually arise. According to the investigation, we understand that this situation is mainly caused by the waste of health insurance resource and the huge amount of hospital application costs. Though the national health insurance has tried to encourage the patient seeing a doctor in the basic level hospital (ex. clinic) in term of partial payment system, the effect of the system is obviously limited. In order to run the system more effective, understanding the patient’s behavior of taking medical treatment become a crucial task. In this research, a traditional Probit model was constructed to illustrate patient’s decision behavior. The main objective of the developed model is to explore the identification of patient heterogeneity and to understand why patient would choose their specific hospital by using the Hierarchical Bayesian Model (HBM). To demonstrate the effectiveness of the proposed model, the data from Taiwan National Health Insurance Research Database was used. Based on actual application results, we have discovered that the key factors which affect patients choosing hospital level can be successfully identified.
36
Cheng, Jui-Ying, e 鄭瑞英. "The Study of Medical Care Seeking Behavior of Elderly People under National Health Insurance". Thesis, 2004. http://ndltd.ncl.edu.tw/handle/50019246821386708647.
Abstract (sommario):
碩士中國醫藥大學
醫務管理研究所
92
Objectives. This research focus on the health care utilization variations among elderly persons (age greater than 65) between “Chinese and western medicine” care pattern group and “western medicine” care pattern group. This study also explored whether elderly persons had significant doctor shopping behavior. Methods. This study has used the National Health Insurance Research Database of 100,000 Beneficiaries Claims Data Files in 2002, and selected outpatient visit data of people aged 65 and over. The data set include 8,429 elderly people, and have been divided into several medical care utilization pattern groups, as follows: “Chinese and western medicine care group,”“western medicine care group,” “plural care group,” “ non-plural care group,” “ doctor shopping group,” “non-doctor shopping group,”. The descriptive statistic, t-test, χ2-test, and Logistic regression analysis are conducted to analysis the data. Results. 1. There are 2,047(24.9%) people in the Chinese and western medicine group, among this group 1,327 people are plural care users, and 685 people of these users have significant doctor shopping behavior. The other 6,382(75.7%) people are in the western medicine care group, among this group 3,559 people are plural care users, and 1,620 people of these users have significant doctor shopping behavior. 2. The most common diseases of these people are “Acute Upper Respiratory Infection,” “Hypertension,” and “Diabetes Mellitus.” 3. Patients whose characteristics are older, with chronic diseases, with higher emergency visits, with higher number of different outpatient doctors, with higher inpatient visits, or at higher physician density regions have low probability to use both Chinese and western outpatient services. Patients with higher number of different outpatient specialties or clinics visits, or at higher Chinese physician density regions have high probability of combined use of Chinese and western outpatient services. 4. Persons with co-payment, or with high different outpatient clinics visits have low inclination of plural medical care. However persons with chronic diseases or higher emergency visits, or higher outpatient visits, or higher number of different outpatient doctors, the higher probability of plural medical care. 5. Patients with chronic diseases, catastrophic illness, higher emergency visits, higher inpatient or outpatient services, or with higher number of different outpatient doctors have high probability of doctor shopping behavior. On the Contrarily, patients with higher number of different outpatient specialties or clinics have low probability of doctor shopping behavior. Conclusions. Senior citizens with chronic disease, with higher outpatient, emergency and inpatients visits, or with higher outpatient doctors contact seems to show higher probability of doctor shopping behavior. Physicians should take more care of medical care needs of elderly people, and manage patient relationship well to avoid the plural care pattern or the doctor shopping behavior which arise from patients’ dissatisfaction of outpatient service.
37
Liao, Chi-Hui, e 廖智慧. "The Impact of Second Generation National Health Insurance Supplementary Premium on Individual Investors Behavior". Thesis, 2014. http://ndltd.ncl.edu.tw/handle/91320064624809627407.
Abstract (sommario):
碩士亞洲大學
國際企業學系碩士在職專班
102
This paper discusses the influences of the supplementary premiums of the Second-Generation National Health Insurance (NHI) program on the investment behavior of individual investors in the Taiwan stock market. The Second-Generation NHI program went into effect in 2013; thus, the researcher used the listed companies in Taiwan that distributed cash dividends from January 2012 to December 2013 as the research samples and applied the event study method for examining the influence of the Second-Generation NHI program on the investment behavior of individual investors in Taiwan. The empirical results are presented as follows. (1) According to a comparison of the dividend income earned by the individual investors in 2012 with that earned by the individual investors after the program was launched in 2013, abnormal returns received by the investors prior to the ex-dividend days in 2013 were significantly higher than those received in 2012, implying that the trade behavior of the individual investors were affected by the new policy. The research further involved comparing the stocks in the electronic and traditional sectors in 2012 with those in 2013. After the new policy was implemented, the average abnormal returns of the electronic sector after the ex-dividend days achieved a positive level of significance, and the abnormal returns of the traditional sector prior to the ex-dividend days were significantly positive. Implementing the program to collect supplementary premiums from dividend income affected stock prices before ex-dividend days. (2) This study used the stock turnover rate as the proxy variable for emotions of the individual investors and concluded that the stock turnover rates before and after the ex-dividend days in 2013 were significantly higher than those in 2012. Implementing the program prompted the individual investors to become emotionally agitated before and after the ex-dividend days in 2013. Moreover, the results of a comparison of the cash dividends in 2012 and 2013 imply that low cash dividends had significantly positive abnormal returns, which affected the emotions of individual investors, causing investment changes in the stock market.
38
Lin, Hui-Wen, e 林惠雯. "The Knowledge, Attitude, and Behavior of Health Services Consumers and Providers under National Health Insurance Outpatient Drug Co-payment Program in Taiwan". Thesis, 2001. http://ndltd.ncl.edu.tw/handle/40108977470040514184.
Abstract (sommario):
碩士國立臺灣大學
醫療機構管理研究所
89
The purpose of this research is to understand the perception, attitude and behavior of patients and health care providers under the new Outpatient Prescription Drugs Co-payment Program policy of the National Health Insurance (NHI). The new co-payment policy has been taking place from 1st, August 1999. This research has two sources of data. One is a nation-wide random sampling survey for the patients. we got 946 valid respondents by telephone interview with CATI(Computer aided telephone interview). Other set of data is from a radon sampling survey for the physicians. We used a self-admission questionnaire to collect data. The response rate is 16.7%. (688 valid questionnaires returned). The results of this research are： （1）Regarding whether the patient know about the new outpatient prescription drug co-payment policy, there are still one-fifth of patients don’t know this new policy, even though this new policy has taken place for 18 months. Meanwhile, patients who received receipts have a higher rate knowing this new policy than the patients who did not receive receipts. （2）Regarding the attitude toward this new outpatient prescription drug co-payment policy, there are about 70% of patients can accept this policy. It means the concept of user charges is popular among patients. （3）Regarding patient behavior, only 4.56% patients asked physicians to provider low drugs, and 11.57% reporter they have made lower visits to the doctors. Moreover, whether patients will reduce outpatient visits or drugs utilization are affected by the perception of the new outpatient prescription co-payment policy. （4）Regarding the impact on health status, 33.73% patients reported their health status adversely, especially for the high users. 28.24% reported the new policy caused final burden on them. Most of them are the patients with low income and low level of education. （5）41.52% patients reported they would reduce their satisfaction toward NHI because of the new Outpatient Drug Co-payment policy, especially for these people with low level of education and having finical burden. （6）Regarding whether physicians will change prescriptions patter because of the new outpatient drug co-payment policy, 10.31% physicians reported they tended to prescribe drugs under NT 100, 22.6% reported they would prescribe drugs over NT 501 or prescribe more the days of drugs.
39
"Essays on determinants of health insurance choice and medical care demand and their effect on individual behavior". THE UNIVERSITY OF CHICAGO, 2010. http://pqdtopen.proquest.com/#viewpdf?dispub=3387052.
40
蔣隆霞. "The Study on Female Military Officer’s Medical Visiting Behavior after Incorporation into the National Health Insurance System". Thesis, 2005. http://ndltd.ncl.edu.tw/handle/65972837277874414611.
Abstract (sommario):
碩士大葉大學
國際企業管理學系碩士在職專班
93
The point of this article is to analyze the utilization of medical services and related factors to the satisfaction of medical care that a female military officer have under the current National Health Insurance system as well as to analyze multiple effects on medical visiting behavior in order to inform and improve the Armed forces military medical system completely and reach the goal of long-term business. The methods of descriptive statistics, t-test, variable analysis (ANOVA) and so on were included and effects on medical visiting behavior were analyzed in advance. Following is the result: Individual variable versus medical service providers and medical visit experience: Most testes prefer military medical centers, but OPD was chosen concerning civil medical service providers. As for the medical visit experience, most female military officers visit general internal medicine doctors, ENT doctors, dermatologists and ophthalmologists more frequently. Predisposing factor versus medical care satisfaction to military and civil medical services providers “Age”, “Rank”, and “Residence” all have apparent differences in satisfaction degree of visit to military medical services providers. However, only “Age”, and “Residence” have apparent differences in satisfaction degree of visit to civil medical services providers. Female military officers’ medical care satisfaction to military medical services providers and it’s affecting factors. Enabling factor make female military officers’ medical care satisfaction to military medical services providers more different after incorporation into National Health Insurance. However, need factor doesn’t. Female military officers’ medical care satisfaction to civil medical services providers and it’s affecting factors. Enabling factor doesn’t make female military officers’ medical care satisfaction to military medical services providers apparent different after incorporation into National Health Insurance system. And neither do need factor. The effect of Female military officer’s medical care satisfaction and medical visiting behavior. Female military officers’ medical care satisfaction to military medical services providers is better than that to civil medical services providers. However, concerning the medical visit, civil medical services providers were preferred. In order to make Armed forces military medical organization work forever, renewal of military medical organization must be accelerated. Moreover, improvement of medical services and making stricter budget are equally important so as to acquire the advantage in the hard medical competition.
41
Lin, Jia-Syuan, e 林佳璇. "The Impact of the National Health Insurance's Reduce Co-payment Policies in remote areas on Patient’s Health-Seeking Behavior". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/35498506899523823498.
Abstract (sommario):
碩士東海大學
企業管理學系碩士班
104
The Bureau of National Health Insurance (BNHI) had reduced of 20% co-payment of outpatient, in 45 remote areas to patient’s since January 1st, 2013. We analyzed the outpatient utilization of one million NHI enrollees for 2000, used the sign test model to examine the effect of the new policy on the probability of health seeking behavior, and the number of outpatient visits. Major empirical results are as follow： 1. The decrease of 20% co-payment for remote areas has significantly effect on the services volume of remote areas. 2. The decrease of 20% co-payment for 40 remote areas has significantly effect on the services volume of remote areas.; The decrease of 20% co-payment for 5 remote areas has no significantly effect on the services volume of remote areas Overall, we found that reduced of 20% co-payment policy it would significantly increase medical demand of outpatient services
42
SHUO, TSAI KAO, e 蔡高碩. "The Influence on Physicians’ Prescription Behavior by Current Policy of National Health Insurance, Hospital Business Strategies and Pharmaceuticals Promotion". Thesis, 2006. http://ndltd.ncl.edu.tw/handle/79126053513499509804.
Abstract (sommario):
碩士輔仁大學
管理學研究所
94
Since the National Health Insurance Scheme has been enforced in Taiwan, the government has launched several policies including the Separation of Prescribing & Dispensing (SPD) policy, global budget system, increase of co-payment, etc., thus creating effects of different extents on the overall medical and pharmaceutical environment. In line with health insurance policies, hospitals sometimes need to tap new resources and economize on expenses by requiring pharmaceutical plants to lower the selling price of pharmaceuticals and requiring physicians to prescribe pharmaceuticals of higher profits or lower costs, thus seriously affecting the survival space for the pharmaceutical industry. Given the procurement of prescription drugs is considered an organizational procurement act, pharmaceutical plants play unique and multiple roles in the procurement of pharmaceuticals, even though patients are the end-users of pharmaceuticals. In this way, physicians of hospitals and clinics, rather than the actual end-users of pharmaceuticals, are the targets of the western pharmaceutical industry providers for promoting prescription drugs. In summary, the purpose of this study is to discuss physicians’ opinions on the promotional activities of pharmaceutical plants and their degree of participation in such promotional activities as well as the factors that physicians consider in the choice of pharmaceuticals. Through the in-depth interview method, this study has organized and drawn conclusions from the collected interview contents. We summarize our findings as follows: (1) If the health insurance reimbursement is based on the fee-for-service system and hospitals consider the quality of care more important in the choice of pharmaceuticals, pharmaceutical plants will put a greater emphasis on product quality; therefore, professional physicians of a cognitive orientation are more willing to accept the promoted prescriptions; (2) If the health insurance reimbursement system adopts the case payment and hospitals consider the costs of health care more important in the choice of pharmaceuticals, pharmaceutical plants will increase promotional activities; therefore, physicians of a target income orientation are more willing to accept the promoted prescriptions; (3) If the health insurance reimbursement is based on the global budget system and hospitals consider the quality of care more important, pharmaceutical plants will upgrade the professional knowledge of their sales representatives; therefore, professional physicians of a cognitive orientation are more willing to accept the promoted prescriptions; and (4) If the health insurance reimbursement is based on the global budget system and hospitals consider the costs of health care most important, pharmaceutical plants will upgrade the professional knowledge of their sales representatives; therefore, physicians of a defensive medical orientation are more willing to accept the promoted prescriptions.
43
Wang, Po-Wei, e 王柏為. "Physician acceptance behavior of the national health insurance PharmaCloud query: An Extended Unified Theory of Acceptance and Use of Technology". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/ju3s3e.
Abstract (sommario):
碩士嘉南藥理大學
醫務管理系
104
With Internet technology matures, its value is also used in health care a substantial increase in view of this, the Ministry of Health and Welfare Department's Central Health Insurance proposed NHI Cloud medication record query system in the Republic of China in July 102, NHI drug Cloud calendar providing special medical services physicians in clinical management, prescribe, and pharmacists drug counseling for immediate query of patients over the past three months, medication record, so that the physician can more quickly understand drug information of patients and medical decision-making, in order to avoid duplication dangerous drugs, so that more people on medication safety, can also reduce the cost of care. But the past literature noted that the implementation of information technology often suffer physician resistance, resulting in build failure can not realize its benefits. Therefore, this study aimed to 1. Understand the physician to use the status of health insurance Cloud medication record query of; 2 by the UTAUT point of view, to explore "performance expectations", "efforts to expect," "Social Impact" and "promote the conditions" for health insurance Cloud medication record query uses intentions; 3. Discussion physician network platform of third-party security mechanism is institutional trust, acceptance of applications in science and technology, health care for the cloud medication history queries intended use of. In the past in the medical literature related to the field of information in order to accept the use of integrated science and technology-based mode to do and to understand user behavior, it is the ability to get a good explanation. Therefore, this study will be integrated using the technology acceptance model as a theoretical basis for health care physician to explore cloud medication history queries intended use and integration of institutional trust to explore behavioral patterns of health care physician intention to use the cloud medication history, and proposes seven hypothesis. The present study used questionnaires to hospital level is divided into three levels, the physician investigated in this study were distributed out of 150 questionnaires, 142 valid questionnaires recovered, the recovery has to be 94.6%, after then to structure equation model and SPSS statistical software to verify hypotheses. The results of this study indicate performance expectations, and strive to expectations, institutional trust and social impact of the most significant (P <0.001), while the normal situation and the institutional structure to ensure trust significant (P <0.001). Expected results of this study can be used as the central health authorities, hospitals and medical information industry to the health-care drugreference calendar Drive Executive and Management Strategies, and gain the academic success of health insurance Cloud medication history of research and sustainable use of the measure.
44
Liang, Si-Han, e 梁思涵. "The Research on the Donation Behavior and Market Segmentation of Staff of Bureau of National Health Insurance, KAO-PING Branch". Thesis, 2008. http://ndltd.ncl.edu.tw/handle/91386652986176198396.
Abstract (sommario):
碩士高雄醫學大學
醫學社會學與社會工作學研究所
96
After the launching of National Health Insurance program, although most people have joined NHI, there is still 900,000 uninsured population can not afford the fee of NHI due to poverty. In such circumstances, even though our government has constructed relative laws to assist the uninsured population to join and possess the protection of NHI, there are some disadvantaged minorities that do not meet the qualifications of subvention from government and also can not afford the expense of NHI at the same time. In the process of dealing with these special cases in the Bureau of National Health Insurance, KAO-PING Branch, they found these social issues existed and started the assistance programs for disadvantaged minorities. The program of voluntary donation behavior of staff is one of assistance programs, and it is also the main topic of this research. This research is from the viewpoint of market segmentation in marketing to separate staff into “donate” and “not donate” depending on the donation behaviors. From the research we can not only have well understanding of the existing circumstances of staff’s donation behaviors but make a thorough inquiry into the relative factors that may affect donation behaviors. In the methodology, this research uses the methods that combined quantity and quality. At first, it goes through the investigation from 232 significant questionnaires and uses the distribution of frequency and percentage to describe and analyze the staff’s donation behaviors, the motives of donation, causes of continued donation, and the causes of stop donation. From chi-square test, we can know if there are differences of staff’s donation behaviors under different characteristics of population. And from analysis of variance, we can probe into if there are differences of the motives of staff’s donation behaviors and the causes of continued donation and stop donation in different characteristics of population. Besides, researcher picks 16 staffs to be the sample of phone interview with quota sampling method which depended on the situations of staff’s donation behavior in the questionnaire. We can not only have better understanding of the motives of staff’s donation behaviors and the causes of continued donation but also realize the staff’s attitude about the assistance programs for disadvantaged minorities, the reasons of “to donate” or “not to donate”, and the relative factors that may affect the will of staff to donate. The results of this research are listed below: 1、In the chi-square test of donation behaviors (“donate” or “not donate”) and the variance of population statistics, although “degree of education” is the only one significant difference can be found, we can still know the distribution of population of “donate” and “not donate.” 2、There are significant differences caused by differences of population statistics in the donation frequency, amount of donation, times of donation, will to donate again, motives of donation, causes of stop donation, and so on. 3、From the results of phone interview and questionnaires, we can know that the will of staff to donate is determined mostly by the usage of expense, efficiency, demand of assistance of the disadvantaged minorities. Therefore, researcher suggests that Bureau of National Health Insurance, KAO-PING Branch should proclaim the information about the need of disadvantaged minority cases and announce the usage of expense, results of these cases periodically in order to make staff know the donation is in good usage.
45
Kan, Hsing Chieh, e 闞興潔. "A Research on Attitude, Behavior and Strategies of Contracted Hospitals Responding to the Dispute Review System of National Health Insurance". Thesis, 2000. http://ndltd.ncl.edu.tw/handle/10690712209721401712.
Abstract (sommario):
碩士國立臺灣大學
醫療機構管理研究所
88
The major aims for this study are to analyze the attitude for hospitals of different organized properties toward current Dispute Review System of National Health Insurance (NHI), to probe into related factors, to find out the frequency and cause for hospitals on application to dispute, to inquire into conditions how hospitals manage and control the process for petitions, reply, and dispute, and to comprehend the influence on acquired the rate of making a deferred payment. This study adopts the method of general investigation. The questionnaire is nationwide directed to survey 571 hospitals above district levels with which NHI contracted, and use related data from 1995 to 1997 offered by BNHI and Dispute Mediation Committee to analyze. The overall recovery rate is 38.16%. The following are main results： Eight conclusions analyzed directly from the questionnaire： 1. Near half of hospitals consider that current procedures for applications of dispute are not simple and convenient. 2. About seventy percent of Hospitals feel satisfied with services by Dispute Mediation Committee. 3. Sixty percent of hospitals are not pleased with judgment by Dispute Mediation Committee. Major reasons are two：one is to fail of taking patients' specific characteristics into consideration; the other is inconsistent criteria of judgment. 4. About one third of the hospitals received few reasons mentioned on documents of judgment. 5. On average, the practical period of judgment of current hospitals is 6.12 months. And the period that hospitals expect is 2.42 months. 6. Most of the hospitals often apply for dispute. Frequency of applications is in direct proportion to hospital levels. district hospitals get the lowest dispute rate. 7. About Seventy percent of hospitals implement managing and controlling strategy in petition and reply stage, but only forty percent in dispute stage. After controlling related factors and analyzing further into the results by multiple regression, this study found： 1. Hospitals that feel convenient when filling out application forms of dispute have a better satisfaction of procedures for applications of dispute. 2. Hospitals that have offered cases to Dispute Mediation Committee have a better understanding about dispute operations. 3. Both "the rate of compensation through administrative measures for dispute cases" and "satisfaction for curtailment after verification" have influences on the satisfaction of judicial results. 4. The frequency and content of reasons mentioned for curtailment after verification would produce an effect upon the satisfaction of the reasons. 5. Dispute rate of public hospitals is not obviously higher than that of private hospitals. 6. Hospitals that implement the strategy of managing and controlling in dispute stage get lower dispute rate. 7. In petition and reply stage, with or without the strategy of managing and controlling, there are no influences on the rate of making a deferred payment for the petition as well as reply cases of outpatient service and hospitalization. 8. In dispute stage, with or without the strategy of managing and controlling, there are no influences on the rate of administrative relief for the dispute cases of outpatient service and hospitalization. This study analyzed and organized results mentioned above to provide hospitals, Dispute Mediation Committee, BNHI, and future researcher with suggestions and for improving policies.
46
LIN, PO-SHENG, e 林伯聲. "A Study of Factors that Influence Patient''''s Medical Care Seeking Behavior at Bureau of National Health Insurance Outpatient Centers". Thesis, 2002. http://ndltd.ncl.edu.tw/handle/11852674742503534157.
Abstract (sommario):
碩士國立高雄醫學大學
公共衛生學研究所碩士在職專班
90
Abstract This study assessed the relative importance of factors and decision behavior affecting patient’s medical care seeking behavior at Bureau of National Health Insurance Outpatient Centers, so our study aims to understand (1) patient satisfaction of service structure of medical care.(2) patient satisfaction of service process of medical care. (3) patient satisfaction of service results of medical care. (4) the moderation of predisposing factors and enabling factors. As stated above could affect patient’s medical care seeking behavior at Bureau of National Health Insurance Outpatient Centers. (5)The factor in patient satisfaction of service structure, service process and service results of medical care could predict that patient’s medical care seeking behavior at Bureau of National Health Insurance Outpatient Centers at the same time. (6)Estimating model for the probability of continually selected Outpatient Centers for medical care. To have the data covering a wide variety of information , the current study surveyed the patients of Taichung & Kaohusiung Outpatient Centers and randomly selected samples from 1995 till 2002 , to obtain 1125 samples from 180,000 samples of chr. disease, finally only 856 valid questionnaires were obtained for service satisfaction analysis in the 14 factors. Those samples was divided in to two groups; group 1 was continuance of selected Outpatient Centers for Medical care(428 samples)from march 1995 till 2002,and another group( group 0) was discontinuance of selected Outpatient Centers for Medical care(428 samples)since march 1997 , meanwhile frequency, description correlation factors analysis, chi-square, t-test and logistic regression analysis including effect of moderating variables were used to analyze the data of 856 valid samples. The results indicate that (1) the service structures of medical care including outpatients delivery process. hi-tech equipment modern (equipment / technology),convenient location and parking & transportation problem (2) the service results of medical care including service attitude of physician, service attitude of nurses, environment, physician’s medical expertise and ethics, reputation Outpatient Centers, Image of Outpatient Centers and stable or good results after treatment were the top eleven important factors of two dimensions for those affected patients when they were choosing Outpatient Centers. The logistic regression equation for probability of continuance of selected Outpatient Centers for medical care could be written as Prob(event)= .where Z=-8.29+0.28(patient satisfaction of service structure of medical care)-0.33(patient satisfaction of service process of medical care)+0.29(patient satisfaction of service results of medical care). Finally, the important finding in study including the probability of continuance of selected Outpatient Centers for medical care showed significant difference under the predisposing factors of the service structure and results of medical care but no significant difference under the predisposing factor of the process of medical care. Meanwhile, the moderating variables of family income and period of OPD showed significant interaction effect to the dimension of service structure of medical care. Therefore, findings form the present study could provide information for the manager of Outpatient Centers to understand potential consumers and develope effective methods especially the dimensions of service structure and process of medical care of attracting clients under the consumers’ needs. Key words ：logistic regression analysis，factor analysis ，moderating variables
47
You, Chih-Chiang, e 游志強. "Impacts of Case Payment System of National Health Insurance on patient selection and claim behavior of the hospitals,1996~2004". Thesis, 2006. http://ndltd.ncl.edu.tw/handle/62893920074328860436.
Abstract (sommario):
碩士國立陽明大學
衛生福利研究所
94
In order to correct medical behaviors and improve the efficiency of health service, the Taiwan Bureau of National Health Insurance (BNHI) has introduced the Case Payment System (CPS) since the inception of the NHI. Until now there are total of 53 cases subject to CPS. Due to the lacking of well-defined case-mix system and the partial implementation of CPS, hospitals might select patients or claim alternative ways to escape from regulation of the CPS. Thus lead to the reduced access to and efficiency of health services. The goals of this study were to evaluate the impacts of CPS implementation, financial characteristic of each Diagnosis-Related Group (DRG) or case, and hospital characteristics on patient selection (patient transfer) and claim behavior of the hospitals based on the analysis of long-term (9 years) NHI claim data. Secondary data analysis was conducted based on National Health Insurance Research Database (NHIRD) provided by National Health Research Institutes (NHRI).We selected the patients who received CPS-related operations from the National Health Insurance Registry for 200,000 Beneficiaries Claims Data Files from 1996 to 2004. Patient were defined as transfer patients if they had any inpatient record in anther hospital on the same admission date or had any outpatient record of the same conditions/diseases in anther hospital three days before the admission date. The claim behavior was defined as following or not following CPS claim regulations. The financial characteristics include DRG Relative Weight (DRG RW) and case profit. The former were defined based on the relative weight of each DRGs by Taiwan DRGs version 3 (Tw-DRGs, 3.0) announced by BNHI. The latter were according to the extent of the adjustments based on the Taiwan Relative Value Scale (TRVS,2.0). The hospital characteristics include the ownership, levels, and BNHI sub-bureaus. χ2 test, t test, and logistic regression were conducted by SAS 8.0 software. Major results were as follows: Regarding patient selection, we found CPS implementation, financial characteristics, and hospital characteristics all significantly related to patient transfer. Overall, CPS implementation reduced the likelihood of hospital transfer yet the effects were different among hospital with different characteristics. Patient lived at Northern Branch were significantly more likely than Taipei Branch, patients of regional hospitals were significantly more likely than medical center hospitals, and patients of private hospitals were significantly more than public hospitals to be transferred. Financial characteristics also played significant role. The effects of DRG RW on patient transfer of district teaching/district hospitals were stronger than that of the medical center hospitals. Regarding claim behavior, we found that after implemented the CPS, financial characteristics and hospital characteristics all significantly related to claim behavior. For DRGs/cases with higher RW or low profit, hospitals were less likely to claim on CPS. However, the association between financial profits and CPS claim depended on the extent of DRG RW. For high RW cases, hospital tended not to claim on CPS regardless of profit. Hospitals in Taipei Branch were less likely to claim CPS than that of Kao-ping Branch. Financial profit played a more important role for hospitals at Eastern Branch than that at Taipei Branch. Compared with medical center hospitals, regional, district teaching, and district hospitals were less likely to claim CPS. The influences of DRG RW and profit on district teaching hospitals and district hospitals were significantly more than that of medical center hospitals. Private hospitals were less likely to claim CPS compared with public hospitals. Based on the above results, we have the following suggestions: 1. BNHI should monitor patient transfer patterns of hospitals regularly. 2.BNHI should fully implement the T-DRGs to reduce the opportunity for gaming of hospitals on CPS claim 3. BNHI should closely monitor the transfer and outlier case after T-DRGs are full-implemented. 4. DRGs Recalibration should be conducted regularly to rationalize the payment. 5. Change the payment to outlier cases (way from fee-for-services) to reduce the incentive to claim outliers. 6. Refined the DRGs classification system to reduce the likelihood of gaming on the claim. 7. Might develop better measurement for financial incentive in future researches.
48
Jeng, Kun-Chang, e 鄭琨昌. "Effects of the financial incentives on the medical behaviors under the system of the national health insurance : A medical system in Taoyuan". Thesis, 2004. http://ndltd.ncl.edu.tw/handle/47951344231197317920.
Abstract (sommario):
碩士淡江大學
管理科學研究所
92
Title of Thesis：Effects of the financial incentives on the medical Total pages:85 behaviors under the system of the national health insurance：A medical system in Taoyuan Key Words：National Health Insurance, Payment System, Physician Payment Arragement, Medical Behavior, Financial Incentive Name of Institute：Tamkang University, Graduate Institute of Management Sciences Graduate Date：June, 2004 Degree Conferred：Master’s degree Name of Student：Kun-Chang Jeng Advisor：Dr. Hai-Ming Chen Abstract： The objective of this research is to discuss the effects of financial factors caused by policies and payment systems of Taiwan’s National Health Insurance System on doctors’ salary system in hospitals, hospital management strategies and medical behaviors. In accordance with the research objective, literature review and case study methods are used to develop five fundamental research aspects, including characteristics of hospitals, the national health insurance system, doctors’ salary system, hospital management strategies and medical behaviors. In terms of characteristics of hospitals, the national health insurance system and doctors’ salary system, data of case are conducted to establish medical systems and management processes, and also to analyze internal and external environment factors that lead to their impacts on the medical behaviors. The results of the study are hoped to serve as references in practical business management for future managers of medical institutions. The research results are as follows: 1.The impact of the health insurance policy on medical behaviors is far greater than the involvement of hospital’s internal management system; the payment system also affects the intensity of medical care, medical behaviors, medical quality, organization efficiency and hospital’s management. 2.In response to the impact of the health insurance system on their operations, medical institutions put into practice the physician fee (PF) system in view of gaining monetary benefits; however, the expansion of the management system interferes with medical behaviors, and at the same time causes conflicts between doctors and hospitals. 3.In order to survive in the environment, medical institutions formulate many responsive strategies so the health insurance system’s regulatory measures and norms cannot achieve the expected results. 4.Since the payment system of the health insurance regime fails to consider time and risk incurred by doctors in discharging their medical duties, the system is viewed as not achieving fair and reasonable payment standards. Moreover, when hospitals formulated the PF system, the emphasis is put on labor, and as a result, doctors have doubts as to the reasonableness of the design of the PF system. 5.Under the profit-seeking mentality, doctors would choose to practice in areas with high-effectiveness and low risk. Owing to this, the payment systems would also have an impact on the choices of doctors’ areas of practice. 6.Due to the financial incentive, the PF system does promote productivity. Nevertheless, those doctors who are devoted to teachings and researches cannot receive a certain degree of rewards, which would lead to the lack of interest in teaching and research work, deterioration of quality and even distortion of values. 7.The payments made under the health insurance payment system vary in accordance with the levels of hospitals. Since the missions and business motives of public hospitals differ from their private counterparts, the doctors’ salary systems and business management strategies of public and private hospitals demonstrate significant differences.
49
Hsiem, Hsu-Ya, e 徐雅仙. "The Study of Relationship Among Job Involvment, Job Satisfaction And Organizational Citizenship Behavior-A Case of National Health Insurance Administration’s Taipei Division". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/d3rkj8.
Abstract (sommario):
碩士世新大學
行政管理學研究所(含博、碩專班)
103
Organizational citizenship behavior (OCB) is paramount for all kinds of organizations. It’s no exception for National Health Insurance Administration, Ministry of Health and Welfare. It is posited that the organization’s members could exhibit a good quality of organizational citizenship behaviorif they can demonstrate strongjob involvement and job satisfaction. As a result, the purpose of this study is to examine the relationship amongjob involvement, job satisfactionand organizational citizenship behavior. The main contents of this study are as follows: (1) constructing the questionnaire as the tool of measurement through the literature review; (2) the survey data is then analyzed by the SPSS, and the statistical methods consist of frequency distribution, T test, One-Way ANOVA, Pearson’s Correlation, and Regression Analysis. The research findings are as follows: (1) the respondents exhibit partial significant difference on the job involvement, job satisfactionand organizational citizenship behavior; (2)the organizational citizenship behaviorhaspartial impact onjob involvement; (3)job satisfaction exertspartial effect on job involvement; (4) the organizational citizenship behavior has significant effect on job satisfaction.Finally, practical implications and suggestions for future researches are made based on empirical findings. Key Words: Job Involvement, Job Satisfaction, Organizational Citizenship Behavior, National Health Insurance Administration.
50
Juan, Chien-Wei, e 阮建維. "The Knowledge, Attitude and Behavior of the Colon Cancer Patient Toward the Payment of Chemotherapy and Targeted Therapy from National Health Insurance". Thesis, 2014. http://ndltd.ncl.edu.tw/handle/15151423309347466917.
Abstract (sommario):
碩士國立中山大學
醫務管理碩士學位學程
102
Objective: The purpose of this study was to evaluate the influences of colon cancer patients’ knowledge, attitude, and behavior in relation to chemotherapy and target therapy. Methods: This was a cross-sectional study. Judgment sampling was used to survey the colon cancer patients of one colorectal surgeon at a regional teaching hospital in Kaohsiung. The validity of the questionnaire used in this study to obtain information from the patients was examined by 5 experts. The total content validity index (CVI) was 93.8%. In September 2013, 22 colon cancer patients were invited to take a pretest. The total Cronbach’s α was 0.946. The formal survey was administered from October 21, 2013 to February 28, 2014, and 173 valid questionnaires were collected. The methods used to analyze the questionnaire results included a t test, analysis of variance (ANOVA), and multiple linear regression analysis. Results: Among the 173 participants who returned valid questionnaires, 65.3% were male and 34.7% were female; the average age was 60.9 years (standard deviation (SD) = 11.1 y). The average accumulated score for the 9 questions on knowledge of chemotherapy and target therapy was 28.45 (SD = 8.46). The average accumulated score for the 9 questions on attitude toward chemotherapy and target therapy was 35.46 (SD = 5.31). The average accumulated score for the 10 questions on behavior during chemotherapy and target therapy was 40.78 (SD = 6.19). If the result of univariate analysis was significant, multiple linear regression was performed. Knowledge was significantly correlated with age, education, marital status, family income, living with grandchildren, living with relatives, television as a source of information, and the Internet as a source of information (R2 = 0.542). Attitude was significantly correlated with knowledge, nurses and case managers as sources of information, and newspapers and magazines as sources of information (R2 = 0.531). Behavior was significantly correlated with attitude, education, and living with sons or daughters (R2 = 0.551). Conclusion: In this study, the independent variable explained the variance in knowledge, attitude, and behavior, which was approximately 50%. Therefore, medical institutions should establish complete procedures for obtaining informed consent, and health education that addresses chemotherapy and target therapy should be provided for colon cancer patients. By increasing the level of knowledge of colon cancer patients, medical institutions could assist these patients in developing and maintaining a healthy attitude during chemotherapy and target therapy, and also motivate patients to adopt a positive attitude toward the entire disease therapy process. Keywords: colon cancer, chemotherapy, target therapy, knowledge, attitude, behavior