醫院權屬別及層級別與醫院照護品質產出相關性之研究─以院內死亡、14天及30天內再入院為例

Research background:
Every country has different insurance system; a sound insurance system needs very long time to build up. There is no exception with national health insurance (NHI) in Taiwan. The policy of initiating NHI enhanced the accessibility of medication for citizens in Taiwan. Yet, the quality and efficiency of healthcare needed to improve. Thus, the health insurance system in Taiwan continuing to change from “fee-foe-service” to “case payment” until “global budget”, and the coming “diagnosis related groups (DFRGs)”. Moreover, ceaseless revolutions are trying to enhance the quality and efficiency. In Taiwan, there had many studies discussed about the effect of hospital ownership and accreditation level on the hospital outcome. However, their results were always not on the same side, some people stated that hospital ownership and accreditation level would had the positive effect on the hospital outcome. Others argued that hospital ownership and accreditation level would pose the negative effect toward the hospital outcome. Still others considered that there is no correlation among those variables. Since there are many evidences in literature show that hospital ownership is a crucial factor while studying for hospital results standing on the basis of volume and outcome theory. We took few indicators for our target of hospital results. Then, see whether hospital ownership influence it or not.

Research objectives:
This paper examines the association of hospital ownership and accreditation level with hospital outcome in Taiwan. We divided all hospitals into three types: public, private for-profit and private non-for-profit hospital. Then, we focused our hospital outcome on “in-hospital death”, “14-days readmission” and “30-days readmission”. Finally, we analyzed whether there had differences between different kinds of hospital ownership and accreditation level.

Method:
This paper examines the association of hospital ownership and accreditation level with hospital outcome in Taiwan. We divided all hospitals into three types: public, private for-profit and private non-for-profit hospital. Then, we focused our hospital outcome on “in-hospital death”, “14-days readmission” and “30-days readmission”. Finally, we analyzed whether there had differences between different kinds of hospital ownership and accreditation level.
Result:
1. In-hospital death: patients in public hospital were higher than patients in private non-for-profit hospital (OR=1.676). Also, the patients in private for-profit hospital suffered higher risk than patients in private non-for-profit hospital (OR=1.038). Still, we found that the risk of patients in medical center was higher than patients in regional hospital (OR=1.254).
2. 14-days readmission: risk of patients in public hospital were higher than patients in private non-for-profit hospital (OR=1.209). Also, the patients in private for-profit hospital suffered higher risk than patients in private non-for-profit hospital (OR=1.054). Risk of patients in medical center was higher than patients in regional hospital (OR=1.115). Also, district hospital had positive significance with 14-days readmission (OR=1.123).
3. 30-days readmission: risk of patients in public hospital were higher than patients in private non-for-profit hospital (OR=1.200). Also, the patients in private for-profit hospital suffered higher risk than patients in private non-for-profit hospital (OR=1.061). Risk of patients in medical center was higher than patients in regional hospital (OR=1.077). Also, district hospital had positive significance with 30-days readmission (OR=1.077).

Conclusion:
In this study, we proved that that the performance of private non-for-profit hospital was the best, followed by private for-profit and public hospital. For the reason that we use secondary database, it would be more complete to collocate with the primary data so that we can get the information that we really want to or interested. Indicators of determining the hospital outcome were very controversial but important and essential. Hence, policy makers should arrange a flexible set of indicators that can fix to the hospitals under different circumstances, or gave them a standard to make them could compare with each other. The factors that would affect the hospital outcome must not only the columns in this database, many other factors of hospitals or patients. Therefore, the government should try to enhance the columns of any aspect in this database progressively.