Use factor analysis to identify difficulties in implementing a case payment reimbursement system in Taiwan

Area of Science:

• Health economics
• Healthcare policy
• Medical reimbursement systems

Background:

• Taiwan's National Health Insurance Program (NHIP), established in 1995, faced financial deficit by 1999 due to rising medical costs.
• A shift from cost-based to case-based reimbursement was proposed to address the financial crisis.
• This study investigates challenges in implementing the proposed case payment system in Taiwan.

Purpose of the Study:

• To identify and analyze the difficulties encountered during the implementation of a case payment reimbursement system in Taiwan.
• To provide insights into the barriers faced by healthcare providers in adapting to new reimbursement models.

Main Methods:

• A four-stage study involving structured interviewing, questionnaire development and testing, surveying, and data analysis.
• A survey was administered to 372 surgeons across 7 teaching and 10 regional hospitals in Taiwan.
• Factor analysis was employed to identify key implementation challenges.

Main Results:

• Factor analysis revealed a five-factor structure explaining 97% of the variance in implementation difficulties.
• The newly developed 22-item scale demonstrated strong internal consistency (alpha = 0.914).
• Key factors identified include barriers to compliance and quality assurance, financial pressures, threats to physician autonomy, and inadequate patient severity allowances.

Conclusions:

• The five identified factors highlight significant challenges in adopting case payment systems.
• Recommendations include annual coding system revisions, physician education, and hospital specialization.
• Addressing these perceived difficulties is crucial for successful healthcare financing reform in Taiwan.