A study of the quality of care of traditional Chinese ambulatory care before the implementation of the global budget payment system in Taiwan

Objectives: To evaluate the quality of care (QOC), the extent of balance billing and the associated factors before the implementation of the Global Budget Payment System of Ambulatory Chinese medicine (GB-CM) of National Health Insurance (NHI). Methods: Telephone interviews were conducted on samples based on stratified random sampling of the providers, and their lists of patients on June 16, 2000. A total of 1837 interviewed were completed (response rate 77%) during June 20 to 30, 2000. Post-stratification was conducted to adjust the age-county distribution of the samples. Multiple linear regressions were conducted. Results: (1) The average overall patients' satisfaction on QOC was 78.6 out of 100; among the different dimensions of QOC, " accessibility" ranked the highest (80.5) whereas the "medical equipment" ranked the lowest (76.1). The satisfaction on "reasonableness of the charge" was lower than QOC (71.1). In general hospital patients were less satisfied than that of clinics. Patients in the Taipei Branch Bureau of NHI were less satisfied than others. (2) After controlling for the patients' and providers' characteristics, the following factors were related to higher satisfaction of QOC: use disposable needles in acupuncture; more days on prescription; Physicians conduct traditional traumatic procedures, acupuncture or moxibustion by themselves; or provided more preventive or self care information; longer visiting time; shorter traffic time/waiting time; no extra-charge. Conclusions: (1) The overall patients' satisfaction of quality of care and balance-billing were acceptable. However, to improve satisfaction, physicians should conduct traditional traumatic; acupuncture/moxibustion therapies by themselves, to avoid the extra-charge to patients if possible. (2) The instrument developed by this study could be used to monitor the accessibility, quality and balance-billing of the providers after the implementation of the GB-CM.