The soaring mechanic ventilator utilization under a universal health insurance in Taiwan

Objectives: The use of mechanic ventilators (MVs) is increasing in many countries. Taiwan's Bureau of National Health Insurance (NHI) launched a new payment program in 2000 to encourage integrated care for mechanically ventilated patients and to reduce the heavy utilization of high-cost intensive care unit. This study examines the trend in MV usage in Taiwan. Methods: This study used nationally representative NHI claim data from 1997 to 2004 to examine the MV usage. Total inpatient days and MV usage days were analyzed by piece-wise regression model. We also analyzed the major diagnoses related to MV dependence. Results: While the total hospital inpatient days increased only 49.41 %, MV usage rose 181.75% over the 8-year study period. The increase in number of MV patient-days in ICUs has not been curbed, besides there was an increase in respiratory care center/wards. Acute respiratory failure (ARF), pneumonia and diabetes mellitus were the leading diagnoses for mechanically ventilated patients. Conclusions: The new NHI insurance payment program may have helped spark the increased trend in MV usage in Taiwan. The significant impact of insurance incentive on healthcare utilization is a critical issue for policymakers in developing healthcare programs. (c) 2007 Elsevier Ireland Ltd. All rights reserved.