Title page for etd-0603104-112826


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URN etd-0603104-112826
Author Hwai-hui Fu
Author's Email Address No Public.
Statistics This thesis had been viewed 5353 times. Download 7765 times.
Department Business Management
Year 2003
Semester 2
Degree Ph.D.
Type of Document
Language zh-TW.Big5 Chinese
Title A Study on Medical Claim Payments Auditing Procedure in Taiwan National Health Insurance
Date of Defense 2004-05-31
Page Count 106
Keyword
  • National Health Insurance
  • Incentive mechanism design
  • Sampling plan
  • Abstract Abstract
    National Health Insurance (NHI) has been implemented in Taiwan for nearly eight years; since then, over 96% of 23 million residents of Taiwan have benefited from this program, and 70% of them are satisfied. Recently, the growth rate of healthcare expenditure, however, has been phenomenally rapid, owing to the ageing population, the economic development, the expansion of health insurance, the increased supply of healthcare resources, and the innovation of medical technology. Under the circumstance that the bill of raising the insurance premium rate could not be passed by the legislative congress, the Bureau of NHI (BNHI) was forced to economize on expense to achieve the financial balance. Currently, the BNHI implements “total amount control” to control the total medical claimed payments of each medical healthcare provider. Facing the increasing volume of documentary auditing, the BNHI has to make its efforts on how to improve its auditing efficiency. This is also one of the purposes of this thesis.
    This study aimed to establish a reasonable and fair auditing procedure of medical claim payment, termed “medical claim payments auditing (MCPA) procedure”. At the stage of professional auditing, adopted the “MIL-STD-105E sampling plan” to select data for professional audit and used the auditing results as a payment criterion. To verify the adaptability of the MCPA procedure, the researcher used the data provided by the institutes of Kaohsiung and Pintong as simulation objects. Further, the estimated cost model was adopted to increase the possibility of using this procedure.
    The MCPA procedure consists of the following characteristics: 1) The number of sampling is much lower than that of the current system used by the NHI, thus the audit labor-force and time can be reduced significantly. 2) The incentive mechanism design encourages the healthcare providers to honestly apply their medical claim payments and avoids inappropriate healthcare services. 3) Adopting international standards of sampling technology makes the MCPA procedure trustworthy and simultaneously can reduce the implementing obstructs.
    Keywords: National Health Insurance; Sampling plan; Incentive mechanism design
    Advisory Committee
  • Iuan-Yuan Lu - chair
  • Ching-Wei Lin - co-chair
  • Ben-Chang Shia - co-chair
  • Hsien-Tang Tsai - advisor
  • Duan Wei - advisor
  • Files
  • etd-0603104-112826.pdf
  • indicate accessible in a year
    Date of Submission 2004-06-03

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