Comparison of Back-Propagation Neural Network, LACE Index and HOSPITAL Score in Predicting All-Cause Risk of 30-Day Readmission.

BACKGROUND: The main purpose of this study is to predict the all-cause risk of 30-day readmission by employing the back-propagation neural network (BPNN) in comparison with traditional risk assessment tools of LACE index and HOSPITAL scores. METHODS: This was a retrospective cohort study from January 1st, 2018 to December 31st, 2019. A total of 55,688 hospitalizations from a medical center in Taiwan were examined. The LACE index (length of stay, acute admission, Charlson comorbidity index score, emergency department visits in previous 6 months) and HOSPITAL score (hemoglobin level at discharge, discharge from an Oncology service, sodium level at discharge, procedure during hospital stay, Index admission type, number of hospital admissions during the previous year, length of stay) are calculated. We employed variables from LACE index and HOSPITAL score as the input vector of BPNN for comparison purposes. RESULTS: The BPNN constructed in the current study has a considerably better ability with a C statistics achieved 0.74 (95% CI 0.73 to 0.75), which is statistically significant larger than that of the other two models using DeLong's test. Also, it was possible to achieve higher sensitivity (70.32%) without penalizing the specificity (71.76%) and accuracy (71.68%) at its optimal threshold, which is at the 20% of patients with the highest predicted risk. Moreover, it is much more informative than the other two methods because of a considerably higher LR+ and a lower LR-. CONCLUSION: Our findings suggest that more attention should be paid to methods based on non-linear classification systems, as they lead to substantial differences in risk-scores.

Analysis of outpatient medical services for correctional institution's inmates entitled to national health insurance: A prison in Taiwan.

BACKGROUND: To formulate better future policies, this study aims to understand the outpatient services provided in a prison in Southern Taiwan by the contracted hospital in two phases. METHODS: Data were analyzed through the outpatient medical services performed by the contracted hospitals in prison in two phases (2013-2015 and 2016-2018). SPSS 20.0 software was used to analyze data such as age, medical fees, department, outpatient visits, average number of visits per patient, and common diseases. RESULTS: The average age of the treated inmates was 49.34 and 47.04 years in the first and second phases, respectively. Most patients belong in the age group of 41-50 years. The number of medical visits per person increased from 15.6 to 20.6 visits. The average medical fee per visit increased from NTD 748 to NTD 775, and the average days of medication per visit decreased from 14 to 13 days. Commonly visited were family medicine, general medicine, orthopedics, and psychiatry departments. Disease of the skin and subcutaneous tissue was the first common disease in both phases, and hypertension was the most common disease. CONCLUSION: The number of medical visits and the average medical fee increased. The medical cost of inmates is higher than the generally insured individuals. If environmental conditions in the correctional facility are improved, the consumption of medical resources will be reduced. There should be a complete therapy and medical treatment plan for mentally ill inmates for a successful return to the society after serving time.

The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident's Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits.

Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents' healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40-49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.

The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups.

BACKGROUND: This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs) on medical resource utilization in inguinal hernia repair (IHR) in hospitals with different ownership to provide suitable reference information for hospital administrators. METHODS: The 2010-2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. RESULTS: There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case) was more efficient than that in the public hospital (US$902.7/case) or nonprofit proprietary hospital (US$817.1/case) surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%), while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. CONCLUSIONS: Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers.

BACKGROUND: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer's perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. METHODS: We obtained our research data using a questionnaire survey (health services providers, n = 201; health service consumers, n = 384). RESULTS: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements (p < 0.001). We identified significant differences in health service providers' and consumers' awareness regarding the transparency of information disclosure (p < 0.001). CONCLUSIONS: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information's applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.

An Assessment of the Application of Pharma Cloud System to the National Health Insurance Program of Taiwan and the Result in Hospitals.

National Health Insurance Administration established Pharma Cloud System in July 2014. The purpose is to decrease therapeutic duplications and enhance public medication safety. Comparison will be made among individual hospitals and the administering branches of National Health Insurance Bureau (NHIB) on the statistical data on the inquiry of the cloud medication history record system to understand the result of the installation and advocacy of this system. The results show (1) there were 2,329,846 entries of data collected from the branches of the NHIB from 2015 on cloud medication history record and 50,224 entries of data from individual hospitals. (2) The inquiry rate at the branches of the NHIB was 43.2% from January to April, 2015 and at individual hospitals was 18.8%. (3) The improvement rate at the branches of the NHIB was 32.5% and at the individual hospitals was 47.0% from January to April, 2015.

Agency problems of global budget system in Taiwan's National Health Insurance.

The main purpose of this study was to investigate the agency problem presented by the global budget system followed by hospitals in Taiwan. In this study, we examine empirically the interaction between the principal: Bureau of National Health Insurance (BNHI) and agency: medical service providers (hospitals); we also describe actual medical service provider and hospital governance conditions from a agency theory perspective. This study identified a positive correlation between aversion to agency hazard (self-interest behavior, asymmetric information, and risk hedging) and agency problem risks (disregard of medical ethics, pursuit of extra-contract profit, disregard of professionalism, and cost orientation). Agency costs refer to BNHI auditing and monitoring expenditures used to prevent hospitals from deviating from NHI policy goals. This study also found agency costs negatively moderate the relationship between agency hazards and agency problems The main contribution of this study is its use of agency theory to clarify agency problems and several potential factors caused by the NHI system. This study also contributes to the field of health policy study by clarifying the nature and importance of agency problems in the health care sector.

Consumption of national health insurance medical resources by hepatocellular carcinoma patients treated using radiofrequency ablation therapy.

AIM: This study analyzed the health-care resources consumed in cancer treatment to provide important reference guidance to national governments with regard to their health-care policy prioritization and efficient health-care resource allocation. METHODS: Researchers used a retrospective observational approach to study medical resources consumed by hospitalized hepatocellular carcinoma (HCC) patients who underwent radiofrequency ablation (RFA) treatment in Taiwan between 2002 and 2006. RESULTS: A systemic analysis of the results showed a mean patient age of 65.3 and average medical costs per patient of US$1403. Higher incidence of HCC was evident in rural areas in Taiwan, however smaller hospitals treated fewer patients diagnosed with HCC due to many patients seeking treatment at larger hospitals, usually in urban areas. Consumption of medical resources at regional hospitals was significantly higher than at medical centers in terms of costs of X-rays and special materials as well as for the overall cost of treatment (P < 0.001). The average medical costs for hospitalized cancer patients who underwent RFA treatment were lower than for those that received other treatments such as surgical resection, TACE, radiotherapy or chemotherapy. This study further found an upward trend in the number of HCC patients receiving RFA treatments. CONCLUSION: Taiwan operates a national insurance global budget payment system. Health-care system budgetary pressures are exacerbated by increases in the costs of cancer treatment. While the cost of RFA for HCC may represent value for money, with cost savings in other treatment areas, it nonetheless places strain on Taiwan NHI global budget payment system.

Agency problems in hospitals participating in self-management project under global budget system in Taiwan.

OBJECTIVE: The main purposes of this study are to clarify the agency problems in the hospitals participating in self-management project within the context of Global Budgeting Payment System regulated by Taiwan government, and also to provide some suggestions for hospital administrator and health policy maker in reducing the waste of healthcare resources resulting from agency problems. METHOD: For the purposes above, this study examines the relationships between two agency problems (ex ante moral hazard and ex post moral hazard) aroused among the hospitals and Bureau of National Health Insurance in Taiwan's health care sector. This study empirically tested the theoretical model at organization level. RESULTS: The findings suggest that the hospital's ex ante moral hazards before participating the self-management project do have some influence on its ex post moral hazards after participating the self-management project. CONCLUSION: This study concludes that the goal conflict between the agents and the principal certainly exist. The principal tries hard to control the expenditure escalation and keep the financial balance, but the agents have to subsist within limited healthcare resources. Therefore, the agency cost would definitely occur due to the conflicts between both parties. According to the results of the research, some suggestions and related management concepts were proposed at the end of the paper.

Synthesis of a novel biodegradable and electroactive polyphosphazene for biomedical application.

To prepare one electroactive and biodegradable biomaterial for biomedical application, a new synthetic strategy was developed to synthesize a novel electrically conductive biodegradable polyphosphazene polymer containing parent aniline pentamer (PAP) and glycine ethyl ester (GEE) as side chains by a nucleophilic substitution reaction. The electrical conductivity of the polymer is approximately 2 x 10(-5) S cm(-1) in the semiconducting region upon preliminarily protonic-doped experiment. The degradation and RSC96 Schwann cells experiments in vitro prove that the polymer is biodegradable and beneficial to the cell adhesion and proliferation. The as-synthesized polymer also shows good solubility in common organic solvent and good film-forming properties. This new type of polymer has potential applications as scaffolds for neuronal and cardiovascular tissue engineering or other biomedical devices that require electroactivity.

Establishment of an integrated management model for the secondary prevention of cervical cancer - an experience in taiwan hospital.

In the present study, secondary data analysis was utilized to evaluate the efficiency of the integrated management model (IMM) on the Pap smear test for screening of women's uterine cervical cancer. The data of female patients receiving a Pap smear test were collected both before (from July to December, 2006) and after (from January to June, 2007) introducing the IMM in a regional hospital in Tainan. The result revealed an increment of participation rate from 5.1% to 15.4% (p < 0.001) among the female patients in the OPD (out-patient department), although the post-IMM participation rate was still much lower than that of general hospital data in Taiwan. Since IMM has proved efficacious for the management of various diseases, improvement in our IMM for the female uterine cervical cancer's prevention and management is conceivable. Studies on influencing factors should be carried out to allow strategies for resolution of problems to be designed, documented and implemented.