Dissertations / Theses on the topic 'Hospitalization insurance'

Introdução - O sistema de saúde brasileiro é composto por um segmento público universal e por um segmento privado. Grande parte da população do município de São Paulo está coberta por planos privado de saúde, porém existem poucos estudos locais explorando a influência desse fator no uso dos serviços de saúde. O estudo de unidades geográficas menores permite um melhor entendimento da realidade local. Objetivo Analisar o uso dos serviços de saúde segundo a posse de plano privado de saúde no município de São Paulo. Métodos - Estudo transversal com base nos dados obtidos no Inquérito de Saúde no Município de São Paulo de 2008. Analisamos o uso de serviços na resolução das condições agudas de saúde, no acompanhamento de doenças crônicas, no rastreamento de neoplasias e na hospitalização. Primeiro realizamos uma análise descritiva dos dados, com estimativa das prevalências. Então, verificamos a associação de cada um dos desfechos com a posse de plano privado de saúde, por meio da regressão logística múltipla, com ajuste para variáveis demográficas, socioeconômicas e da condição de saúde, estimando o Odds Ratio. Resultados As pessoas sem plano privado de saúde apresentaram maior chance de uso de serviços de urgência e emergência. As pessoas com plano apresentaram maior chance de uso de serviços ambulatoriais, de acompanhamento da hipertensão arterial sistêmica, de rastreamento de neoplasias e de hospitalização. Conclusões A posse de plano privado de saúde determinou diferenças no uso dos serviços de saúde no município de São Paulo, havendo iniquidades relacionadas às condições socioeconômicas.
Introduction The Brazilian health system is constituted by a universal public system and a private system. The city of São Paulo has a large insurance coverage but there are few local studies on the influence of this factor on health services utilization. Smaller geographic area research allows for better understanding of the local setting. Objective To analyze health services utilization according to private health insurance ownership in São Paulo. Method We performed a trans-sectional study, based on data from a health household survey performed in 2008 in São Paulo. We analyzed health services utilization in acute health issues, chronic disease followup, cancer early detection and hospitalization. We verified the association between each outcome and the ownership of private health insurance using multiple logistic regression, taking in account adjustment factors as demographic and socioeconomic characteristics and health condition. We estimated the Odds Ratio. Results People without private health insurance had bigger chances of using emergency services. People owning insurance had bigger chances of using ambulatory services and bigger chances of using services for hypertension follow-up and for cancer early detection and hospitalization. Conclusions Private health insurance ownership engendered differences in health services utilization and there are socio-economic related inequalities in São Paulo.

碩士
東吳大學
財務工程與精算數學系
98
In order to understand the protection level of the policyholders under hospitalization limit in cancer insurance, this paper tries to model the cancer patients’ hospitalization after them first diagnosed with cancer. Data with period from 1996 to 2007 is gathered from Taiwan’s National Health Insurance Research Database (NHIRD).Generalized Linear Models had a good fit to the model with the gamma distribution. The main factors of hospitalization are incidence age and gender. Also, the indicator of the patient hospitalized in the first year and which year the patient hospitalized are significant in the model of hospitalization from the second year to twelfth year after incidence.

碩士
東吳大學
財務工程與精算數學系
105
There are various limitation and benefit provisions of hospital income benefit of one-year health insurance provided in the current market, as the result, insured may choose an insurance policy based on lower premium but neglect the coverage. In order to enable insured to choose a suitable insurance policy based on their ages, and insurance companies can also design different products for the target group and provide a variety of options for the insured. In this study, we target to 0~100 years old people, divide them into 19 groups by ages and sexes, and settle 90 days as the claim limit, then use the software @Risk to simulate the average hospital day of every group for calculating net premium rate of hospital income benefit of one-year health insurance. According to the results of the study, there are significant differences of average hospital days between different age groups for both sexes. In order to obtain reasonable premium rate, insurance companies should pay attention to see if it is appropriate to use the same average hospital days for all age groups for rate-making. Different claim limit has different impact to each age levels. In order to choose the policy which is with affordable premium and also can provide adequate protection, premium should not be the only basis for insured, the coverage should be also considered.

碩士
中臺科技大學
健康產業管理研究所
100
Background: Domestic research of medical utilization for chronic respiratory diseases mainly focuses on obstructive pulmonary disease, asthma, and respiratory care. Utilization and cost of medical services for bronchiectasis-associated diseases is an issue seldom discussed in previous research. Based on National Health Insurance Research Database, this study attempted to explore the development of bronchiectasis-associated diseases in Taiwan, utilization and cost of bronchiectasis-associated hospitalization, and factors affecting medical utilization. Methods: From National Health Insurance Research Database maintained by National Health Research Institute, this study extracted hospitalization data of patients diagnosed with bronchiectasis (principal and secondary diagnosis by ICD-9-CM code of 494) during 1998~2008. Using patient characteristic, hospital characteristic, and hospital location as independent variables and cost of hospitalization as a dependent variable, this study conducted univariate analysis, bivariate analysis, and multivariate analysis of the data respectively. Results: Results indicated that a total of 97,912 persons utilized hospitalization services for bronchiectasis-associated diseases during 1998~2008. The hospitalization rate per 100,000 population was 39.5, and the rate was higher among women than among men. Patients aged above 65 had a higher frequency of hospitalization for bronchiectasis. The average length of hospital stay was 11.13 days, and the average cost of hospitalization was NT$47,797.01. Factors affecting hospitalization for bronchiectasis included gender, age, reported salary of the insured, Charlson Comorbidity Index (CCI) score, length of hospital stay, hospital accreditation status, hospital ownership status, and administrative branch of Bureau of National Health Insurance. Conclusions and Suggestions: It should be noted that the prevalence of bronchiectasis was significantly higher among women and people with lower socio-economic status. Therefore, more health education and preventive measures should be provided to these groups of people to reduce incidence of bronchiectasis and medical expenses required. Besides, frequency of hospitalization for bronchiectasis also increased with age. As the ratio of elderly population is on the increase in Taiwan, more emphasis should be placed on preventive care for the elderly.

碩士
東吳大學
財務工程與精算數學系
101
The demand for private medical insurance is increasing in Taiwan as public awareness about healthcare needs. Some of the most popular individual hospitalization insurance plans are limited and fixed premium payment products, with unlimited or lifetime benefits. With the average lifespan increasing and the rapidly rising cost of healthcare, a lifetime benefit creates substantial risk to health insurance providers. Insurance companies have stopped offering unlimited and lifetime benefits. The two types of insurance contracts currently offered either provides limited benefits or the unused portion as a life insurance benefit. Hospitalization benefits can be classified as actual daily medical expense, fixed daily benefit, or the greater of the two. In this study, we consider a hospitalization insurance for newly diagnosed cancer patients with a fixed daily benefit and lifetime claims, with ceilings. We use a generalized linear model (GLM) to analyze thirteen-year inpatient longitudinal data of 695,978 cancer patients, diagnosed between 1997 and 2009, which is approximately a third of Taiwan’s new cancer cases in that period. Data are extracted from Taiwan’s National Health Insurance Research Database via ICD_9_CM codes. Our study indicates that the special GLM model yields reasonable results for annual inpatient days, to be specific, the generalized estimating equation, negative binomial distribution, and exchangeable correlation. We then used copula and simulation methods to determine the net premium required under varied claims ceiling, mortality rates, and correlation coefficients. For premium paying period, we consider both single premium and regular premium. Consider also given to the regular premium with or without rational termination. Our findings are that firstly, there is a correlation for annual inpatient days; the higher correlation for lower premiums. This statement is true for hospitalization insurance with and without a life insurance benefit. Secondly, an increase in the mortality rate will raise the premium for the hospitalization insurance with life insurance benefit, however it will reduce the premium for hospitalization insurance without a life insurance benefits. Third, the net premium reserve depend not only the policy year but also the benefits already paid. Reserve may not be needed in the first few policy years. Fourth, premium is lower with rationality termination consideration than without rational termination.

碩士
中國醫藥大學
中國醫學研究所碩士班
95
Chinese medical insurance was included in the Labor Health Insurance in 1975, the Government Worker Insurance in 1988 and the Farmer Health Insurance in 1989 respectively. Taiwan’s National Health Insurance (NHI) program was established in March 1995, and the Chinese medical outpatient service was included in NHI. So far, the NHI has been established for more than ten years but the Chinese medical hospitalization (CMH) has not yet been incorporated in NHI, still stays in the appraisal stage. It is very important to establish the reasonable fee schedule for developing CMH. This study uses the Delphi method and Grounded theory method to reach a common consensus among the specialists. We held two the specialists meetings in which 33 experts discussed together and gave very helpful suggestions. After the meetings, we arranged all the suggestions and made the Delphi questionnaire. 44 Delphi questionnaires were sent and the results were shown in the two-rounded Delphi questionnaire. There are three parts of the Delphi questionnaire：the first part is “the attitude toCMH”.In the subject of “CMH should be involved in NHI? ”, most experts strongly approved it. In the subject of “partially diseases should be involved in Chinese medical hospitalization”, the attitude of experts turned from approval to strongly approval during two rounds. In the subject of “Chinese herbal medicine should be paid for daily charge? ”, the attitude of experts turned from unapproval to approval during two rounds that appeared that they had different view of it. In the subject of “the cost-sharing for hospitalization of Chinese medical hospitalization should higher than western medicine”, most experts didn’t approve it. The second part is “the evaluation for the subjects of Chinese medical hospitalization”. Most experts approved that the medical center with Chinese medical department is the priority to practice the CMH.The major purpose of CMH is for developing the research of Chinese medicine. The Committee on Chinese Medicine and Pharmacy, Department of Health, Executive Yuan should lead to establish the CMH.Stroke and treatment of post chemo-radial therapy should be prior to be involved in CMH. The third part is “the suggestions of the fee schedule of CMH”. Over 80％ experts approved that room fee of Chinese medical hospitalization, diagnosis fee of Chinese medicine,diagnosis fee of western medicine ,fee of prescription , fee of treatment of acupuncture, nursing care fee of traditional Chinese traumatologic manipulation、fee of nutritional direction、fee of pharmacist、accupressure、splint、pulse signal measurement、electroacupuncture stimulation、nasogastric feeding、testing、X-ray should be paid. Less than 80％ experts approved that altinative chinese medical equipments and fire cupping should be paid. Most suggestive fee were close to the fee schedule of experimental plan,and the fee in second round is closer to fee schedule of experimental plan than the first round. The results are the common consensus for Chinese medical hospitalization procedures among the specialists，and it could be a guideline for Chinese medical hospitalization procedures in the future. We also investigate the distribution of Chinese medical hospitals and doctors in Taiwan, for the preparation for Chinese medical hospitalization.

碩士
真理大學
統計與精算學系碩士班
101
The population aging and the decline of fertility rate has become a serious social problem nowadays. It is inevitable that the demand of medical care is increasing. However, the unceasingly progressing medical technology has caused the medical expense to rise constantly and increase the burden on the health expenditure of people. People thus purchase commercial health insurance products to mitigate risks. It is common that the design of insurance products adopts age and gender as risk factors; however, marital status, physical condition, family medical history and occupation of insured are also possible risk factors. In this research, the National Health Insurance database was used to find risk factors of the incidence of hospitalization and thus apply to the design of medical products. The hospitalization data from 1996 to 2010 of the one million sample of year 2005, which were drawn from the National Health Insurance research database, were used to estimate the hospitalization rate and the average days of hospitalization of unit type of insured. Lee-Carter model is used to fit and forecast the hospitalization rate. There are significantly difference between distinct unit type of insured in hospitalization rate. The premiums of medical insurance of distinct unit type of insured will be calculated and thus providing the insurance company as a reference of insurance product design and underwriting.

碩士
國立交通大學
科技法律研究所
106
For Hospitalization Expense Insurance Policies, "hospitalize" or "hospitalization" means a situation where the insured sustains an illness or injury, a physician makes a diagnosis that hospital confinement is necessary for further diagnosis and/or treatment thereof, formal procedures are followed for admittance to a hospital, and the insured actually resides in the hospital to receive diagnosis and/or treatment. In juridical practice, there are several differing perspectives regarding the issue of whether day-care units of the contemporary mental care model in psychiatric wards qualify as hospitalization expense in health insurance. The grounded theory was conducted in this research for a qualitative study. The analysis was done through interviews with 4 professionals. This article arranges the arguments of each opinions, analyzes the issues from an economic point of view, and proposes advice, references, solutions regarding this issue.

碩士
臺中健康暨管理學院
健康管理研究所
93
Abstract Under the concepts of hospital individual budget and hospital self-management of hospitals, Center of Excellence Plan guides hospitals to replace competition by cooperation and to reduce the innovation risks. In order to correct hospitals’ management principle in focusing on outpatient services but disregarding inpatient ones, the plan concludes outpatient and inpatient services ratio as the necessary index. This study is mainly to confer how Hospital Excellence Plan influences Outpatient-Inpatient Expenditure Ratio and medical treatment. Compiling statistics and analyzing from 49 hospitals of Central, Region Branch, Bureau of National Health Insurance, who have implemented Hospital Excellence Plan since July 1st 2004. The study discovers: 1. After implementing Excellence Plan, though the hospital adjusts Outpatient-Inpatient Expenditure Ratio by inner management and control, the outpatient expenditure ratio still could not lower to 45% in district hospitals; furthermore, the outpatient expenditure ratio of 22 district hospitals is more than 50%, which will cause double loss of outpatient and inpatient expenditure to district hospitals and influence their medical operation. 2. The outpatient counts and cases of all hospitals are fewer, especially of district hospitals; however they still could not reach the target value of Outpatient-Inpatient Expenditure Ratio, which reveals the regulation of 45%: 55% Outpatient-Inpatient Expenditure Ratio is a mission uneasy to achieve for district hospitals. 3. 66% reduced outpatient count of Hospital 16 in medical center is for medicine expenses, and 34% of it is for other outpatient services. Though the outpatients’ medicine expenses in Hospital 8 are reduced, other outpatient expenditures are increased. Above condition reveals that the inner management and control of these two hospitals are very different from each other. 4. Of the reduced outpatient counts, medicine expenses share 61% in regional hospitals, and 69% in district hospitals, which reveals Center of Excellence Plan could appropriately manage and control medicines more and improve the wasted condition. 5. After implementing Center of Excellence Plan , the outpatient operation cases are fewer than before in all hospitals; however outpatient operation counts are more. Both inpatient counts and cases increased, but there is no any obvious information shows that the hospitals turn outpatient operation to inpatient operation. Further conference should be done for tracing the condition. The regulation of Outpatient-Inpatient Expenditure Ratio is incapable to completely control the overhigh outpatient service ratio. Only cooperate with graded referral system, graded medicines expenses share system, open medical information system and health education propaganda could effectively control outpatient medical expenses. Key words: Center of Excellence Plan , Outpatient-Inpatient Expenditure Ratio and district hospitals

碩士
臺灣大學
職業醫學與工業衛生研究所
96
Introduction: With extensive use of hypnosedatives worldwide, in addition to the most commonly reported side effects of sedation, liver injury induced by benzodiazepines (BZDs) has been reported and should be monitored. BZDs, zolpidem and zopiclone all undergo hepatic metabolism. Hepatoxicity has been suspected so the aim of this study was to determine the association between the use of BZDs, zolpidem, zopiclone and the risk of hospitalization related to acute hepatitis. Methods: The study cohort dataset was obtained from the National Health Insurance (NHI) research database in Taiwan from 1997-2004. We separated the groups of patients diagnosed before selected admission of outpatient visits or hospitalization as viral hepatitis B, C, non-viral, non-alcoholic hepatitis, alcoholic hepatitis. Since there were so many determinants, or potential confounders for acute hepatitis, we applied case-crossover design as a means of controlling factors within subjects. Results: 45,626 cases of hospitalization relating to acute hepatitis were obtained. The odds ratio for the first week was the largest and most significant for these medicines. Conditional logistic regression analysis showed a significant adjusted odds ratio of 2.4 (95% confidence interval 1.9, 3.0) for zolpidem during the 7-day risk period. The adjusted odds ratio of zopiclone was 1.5 (95% confidence interval 1.0, 2.4) during the 7-day exposure period. In BZDs, the results were similar to the previous two drugs. In addition, based on the trend of the adjusted odds ratios, another peak was found during the 3 to 6-week period. Discussion: There is an increased risk of hospitalization for acute hepatitis in patients treated with zolpidem, zopiclone and benzodiazepines, and most severe drug induced liver injuries can be idiosyncratic and dose-independent. Thus, physicians and clinical pharmacists should take such potential into consideration and monitor the liver function of patients taking hypnosedatives suspected to be hepatotoxic.

碩士
亞洲大學
健康管理研究所
93
The purpose of this study is to explore the influence on the ratio of inpatient and outpatient expenses for the hospitals that do not participate in the “Center of Excellence Plan”. Based on the health insurance excellent plan implemented as from July 1, 2004 for comparison, the data of 1 branch medical center in central area, 5 regional hospitals, and 61 district hospitals for a total of 67 hospitals that do not participate in the Center of Excellence plan were targeted for statistic analyses. Following are the major positivist findings of this study: 1. There was no significant variance at the ratio of outpatient and inpatient points at various levels of hospitals after the implementation of the health insurance Center of Excellence plan. The variation level was within 2%. For regional hospitals, the ratio remained the same during the pre and after the implementation. It represents that all levels of hospitals do not adjust their ratio of outpatient and inpatient service with internal control measures. It also illustrates that those hospitals that do not participate in the Center of Excellence plan do not change their medical behavior even though the institution of the goal ratio. In other words, they do not use internal control measure to adjust the ratio of outpatient and inpatient service. 2. For the only medical center that does not join the Center of Excellence plan in central area, although its outpatient cases and points showed decline after the Center of Excellence plan, its inpatient cases and points were presented with rising trend, and the ratio was over 5%. It illustrates hospital’s intention to adjust its ratio of outpatient and inpatient service through internal control measures. Even though there is pressure for regional and district hospitals for the ratio of inpatient and outpatient expenses, in order to grab a piece of pie generated from the Center of Excellence plan, they can not help taking measures. One thing worth noting is that whether the limitation of outpatient service for the Center of Excellence plan participating hospitals forces some patients to transfer to the non-participating hospitals resulting in the addition to the non-participating hospitals? If this is the case, are there any patients being rejected for medical treatments? Whether the public medical care rights are affected? All of them are the issue that the health competent authorities shall deliberately explore. 3. Except for the medical center where the medicine expenses for outpatient service has dropped off, the average medicine expenses for outpatient service at regional and district hospitals have actually shown an upward trend after the implementation of the Center of Excellence plan, and the increase rate is 21% and 27% respectively for regional and district hospitals. Among the increased outpatient points, 50% of them are medicine expenses at the regional hospitals whereas 49% at the district hospitals. It indicates that those hospitals that do not join the Center of Excellence plan are less likely to give strict control over medicines. Since fixed points are used for the medicine cost and the hospitals can get some benefit from the medicine price difference, it is quite possible that hospitals may profligately prescribe medicines trying to get some profits. 4. Following the implementation of the Center of Excellence plan, other than the medical center where the points of inpatient operations remain the same, the outpatient and inpatient operation points as well as cases in other various levels of hospitals all show upward trend, and there is also no significant change on the transfer from outpatient operations to inpatient operations. However, it is noticeable that while both outpatient operation points and cases are on the rise, whether the increased points and cases at the non-participating hospitals are resulted from the transfer of the patients who are rejected by the Center of Excellence plan participating hospitals due to patient quota being full, or whether it is the supply inducing demand (SID) phenomena initiated by the hospitals. It means to induce patients to take unnecessary operations. It is also an issue required in-depth investigation by the health competent authorities.

碩士
東海大學
工業工程與經營資訊學系
106
ABSTRACT Tuberculosis is the most common statutory communicable disease in Taiwan and the highest mortality rate. Because infectious tuberculosis patients need long-term hospital isolation treatment when necessary, causing physical and psychological discomfort, social and medical costs. The purpose of this study was to investigate the relationship between comorbidity and length of hospital stay and health insurance costs for patients with active tuberculosis, the relationship between sputum smear findings and comorbidity and length of hospital stay, and health care costs for pulmonary tuberculosis patients, and factors affecting hospitalization days for active tuberculosis patients. . The results of the analysis showed that patients with active pulmonary tuberculosis only had comorbid lupus erythematosus. There was a significant difference in hospital days and health care costs; when more than three diseases were comorbid There was a significant difference in the length of hospital stay with diabetes. Severity of the patient's sex, sputum smear, and comorbidity were related factors affecting the length of hospital stay. When tuberculosis patients have comorbid disease with both lupus erythematosus and diabetes, it is difficult to control the disease because of immune diseases and infections. Patients with severe smear-positive bacteria need a longer time to transfer negative smears, so hospitalization days are longer. To provide reference for preventive health care, clinical care and future health care decisions. Keywords：Active tuberculosis, Comorbidity, Days of hospitalization, Health insurance costs

碩士
義守大學
管理學院管理碩士在職專班
99
The purpose of this article is going through material analysis technology to discuss the influence of the Tw-DRGs payment system during the first year operation regarding the gynecology and obstetrics division in hospital medical service and operation. To provide the reference for the hospital to make the strategy of management focus on the Tw-DRGs payment system follow-up operation. The data are based on the 249 research samples which are the in patient cases of obstetrics and gynecology division of a community hospital in Kaohsiung from January to December 2010. As empirical analysis , this research obtains the following conclusion: 1. There is no significant difference showing the length of stay of obstetric & gynecological hospitalization among the actual medical expense, the Tw-DRGs payment expense, or the expense of case payment 2. The number of diagnosis of obstetric & gynecological hospitalization among the actual medical expense, the Tw-DRGs payment expense, or the expense of case payment showing extremely significant difference. 3. The number of surgery of obstetric & gynecological hospitalization among the actual medical expense, the Tw-DRGs payment expense, or the expense of case payment also showing extremely significant difference. 4. In the case of obstetric & gynecological community hospitalization, the Tw-DRGs payment expense is higher than the expense of case payment.