On the Relationships among Nurse Staffing, Inpatient Care Quality, and Hospital Competition under the Global Budget Payment Scheme of Taiwan’s National Health Insurance System: Mixed Frequency VAR Analyses

Abstract

Background: Time series analyses on the relationship between nurse staffing and inpatient care quality are rare due to inconsistent frequencies of data between common observations of nurse-staffing (e.g., monthly) and inpatient care quality indicators (e.g., quarterly). Methods: In order to deal with the issue of mixed frequency data, this research adopted the MF-VAR model to explore causal relationships among nurse staffing, inpatient care quality, and hospital competition under the global budget payment scheme of Taiwan’s healthcare system. Results: Our results identified bi-directional causation between nurse staffing and patient outcomes and one-way Granger causality running between nurse staffing and reimbursement payments for inpatient care services. Impulse-response analyses found positive (negative) effects of the patient-to-nurse ratio on adverse patient outcomes (reimbursement payments) in all types of hospitals and detrimental effects of adverse patient outcomes on the patient-to-nurse ratio in medical centers and regional hospitals across a 12-month period. Conclusions: These findings suggest that nurse staffing is an essential determinant of both patient outcomes and reimbursement payments. Strategic policies such as direct subsidy and hospital accreditation for appropriate nurse staffing levels should be implemented for medical centers and regional hospitals to mitigate the harmful effects of adverse patient outcomes on nurse staffing.

On the Asymmetric Relationship Between Physician Mental Health Disorders on Quality of Healthcare Under the COVID-19 Pandemic in Taiwan: Quantile on Quantile Regression Analyses

“…This indicator has been suggested by Taiwan's National Health Insurance Administration as a measure of inpatient care quality under Taiwan's NHI system. 52 The outpatient care quality indicator used in this study is the PQI_90 composite, which is calculated in accordance with guideline's provided by the US Agency for Healthcare Research and Quality (AHRQ) in 2020. 54 The PQI_90 composite represents the number of hospital admissions per 100,000 population for outpatient care sensitive conditions (ACSCs).…”

“…51 Nevertheless, previous studies have raised concerns regarding the quality of healthcare services within Taiwan's NHI system, specifically highlighting issues related to shortages in nurse staffing and intense competition among clinics and hospitals. 52,53 Consequently, investigation into the link between physician mental health disorders and healthcare quality is important, providing insights into the potential challenges faced by the healthcare system from the perspective of physician labor input and its impact on healthcare quality.…”