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The Influence of NHI`s Global-budget-payment-system and Doctor-patient Relationship : A Case Study
ABSTRACT
Patients often thought that a good doctor is a doctor who can cure the sickness. However, the traditional obedient attitude of patients toward their doctors and the harmonious relationship between doctors and patients has been strongly challenged due to the progress of science and technology, the abundance of network information, the development of consumer conscious, the change of social status for both doctors and patients, and the increase of citizen knowledge, etc.
The implementation of the National Health Insurance (hereafter NHI) in 1995 is also an essential factor that causes the change of doctor-patient relationship. The Bureau of National Health Insurance (hereafter BNHI), at the beginning, continued using the same system as the Public Employee Insurance and the Labor Insurance in which the insurance pays by fee-for-service. This system consequently led the medical institutions to think highly of quantity rather than quality, and which has almost crashed the NHI. Therefore, for reducing the financial deficit, controlling the increase of medical expenses, and sharing the financial risk with the medical providers, the BNHI brought into practice the dental global budget payment system in 1998 and the global budget payment system for the western medicine clinics in 2002. The new payment system has intervened the doctor-patient relationship, led the medical institutions to change their way of management, and affected further the doctors’ behavior toward patients. In this research, we designed a structure interview and a Likert-scale questionnaire to investigate the influence of the global budget payment system of NHI on the relationship between doctors and patients. All subjects were front-line doctors and nurses working at a medical center. The main results can be summarized as follows: 1. The respondents considered the global budget payment system influenced the relationship between doctors and patients. 2. When there were disputes and misunderstandings between patients and doctors caused by the global budget payment system, the BNHI was perceived to shun away from the disputes. 3. The respondents considered BNHI did not sufficiently make the global budget payment system known to the public. 4. According to the respondents, the doctor-patient relationship did not affect doctor’s treatment plan. 5. A successful doctor-patient relationship relies on doctors and patients. Only when patients trust and respect the professionals and the treatment program will there be a great benefit to both patients and doctors. 6. The payment system of health insurance is a principal factor that influences the manner and the measures of hospital administration. It also exerts a significant impact on the development of the doctor-patient relationship. 7. A good doctor-patient relationship is important in improving the cure rate. For patients, in a harmonious atmosphere, they feel secure to completely rely on doctors and nurses, and are willing to cooperate with medical treatment; for doctors and nurses, they can give patients the accurate diagnosis. 8. A harmonious doctor-patient relationship is of great help for the doctors and nurses to prompt working spirits and to build a stronger sense of achievements. 9. The BNHI, the medical institutions and the insured, they all should be responsible for saving the financial burden of NHI. 10. The objective and the spirit of the NHI should be reconsidered in order to respect and uphold the fundamental principle of social insurance, that is, the medical care.
keywords: doctor-patient relationship, global budget payment system, fee-for-service , medical providers, the insured.
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