Removing anonymity protection and utilization review decisions: a real-world case under a single-payer health system

被引：0

作者：

Wang, Chih-Kuang ^{[1
]}

Chien, Shih-Jung ^{[2
]}

Lee, Po-Chang ^{[3
]}

Cheng, Shou-Hsia ^{[4
,5
]}

机构：

[1] Natl Hlth Insurance Adm, Dept Planning, Taipei, Taiwan

[2] Natl Hlth Insurance Adm, Dept Med Affairs, Taipei, Taiwan

[3] Natl Hlth Insurance Adm, Taipei, Taiwan

[4] Natl Taiwan Univ, Inst Hlth Policy & Management, 17 Xu Zhou Rd,Room 618, Taipei 10055, Taiwan

[5] Natl Taiwan Univ, Populat Hlth Res Ctr, Taipei, Taiwan

来源：

SCIENTIFIC REPORTS | 2022年 / 12卷 / 01期

关键词：

QUALITY-OF-CARE; RELIABILITY; ASSESSMENTS;

D O I：

10.1038/s41598-022-16536-1

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

The effects of anonymity on utilization review has never been examined in the real world. This study aimed to evaluate the impact of removing anonymity protection for claims reviewers on their review decisions. Using a single-blinded repeated measures design, we randomly selected 1457 claims cases (with 12,237 orders) that had been anonymously reviewed and reimbursed in 2016 and had them re-reviewed in a signed review program in 2017 under the Taiwanese National Health Insurance scheme. The signed review policy significantly decreased the likelihood of a deduction decision at the case and the order level (P < 0.001). Furthermore, signed reviewers tended to make more "too lenient" decisions, and were less likely to make "too harsh" decisions. Removing anonymity protection dramatically reduced the deduction rate and overturned the tendency of decisions from "too harsh" to "too lenient". However, whether to maintain the anonymity of utilization reviews is a challenge for health authorities around the globe.

引用

页数：8

共 39 条

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