An exploratory study of AEP on acute hospital admission appropriateness in Taiwan

The Bureau of NHI (BNHI) raised acute bed reimbursement by 34.4-40.5% during 1996-2003 at different levels of hospitals in order to improve quality of care. However, many hospitals were still unsatisfied with the results of the medical review, they complained that the retrospective review which did not include explicit criteria damaged their rights. Therefore, developing admission criteria is of urgent important in Taiwan. Articles or reports regarding medical care appropriateness have focused on medical services. Few have focused on medical setting of Taiwan. An international review criteria " Appropriateness Evaluation Protocol (AEP)", which is a reliable, valid and public-domain tool will be introduced in more detail in this paper and compared with other admission instruments. Although AEP has been endorsed by the studies of many other countries, the criteria of the admission is adjusted in the different countries because of physician differing practice styles and available resources. It also needs a further study to find out those variables that will influence the admission decision, such as whether medical records are the only information source, the difference between reviewed by the retrospective and prospective method etc. Although the global budget payment system was recently adopted by BNHI, there are still no explicit criteria to assess the appropriateness of admission now. If there is no effective mechanism to negotiate between hospitals, over-utilization will be occured in the same way as with previous fee-for-service payment. Therefore, a Taiwanese - version admission criteria needs to be developed in order to provide more efficiently care and resolve the disputes between hospitals and BNHI.