Application of a single sampling plan for auditing medical-claim payments made by Taiwan National Health Insurance

Health Policy
Hwai-Hui FuDuan Wei

Abstract

National Health Insurance (NHI) has been implemented in Taiwan for nearly a decade. Owing to growing demand for medical-care, effective sampling auditing is a key factor in obtaining reasonably priced medical-care services. This investigation proposes a conceptual framework "medical-claim payment auditing (MCPA) procedure" based on the "Military Standard 105E (MIL-STD-105E) single sampling plan" for establishing an objective criterion for making medical-claim payments fairly. The MCPA procedure contributes to the following: (1) meeting international standards of sampling technology; (2) reducing the sampling ratio and consequently auditing costs; and (3) encouraging healthcare providers to honestly apply their medical-claim payments thus avoid wasting medical resources.

References

Feb 6, 1997·Health Policy·T L Chiang
May 17, 2000·Health Affairs·G F Anderson, P S Hussey
Sep 28, 2002·Journal of Health Economics·Frank T DentonByron G Spencer
May 22, 2003·Health Affairs·Jui-Fen Rachel Lu, William C Hsiao

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Citations

Feb 26, 2009·Journal of Evaluation in Clinical Practice·Chinho LinChienwen Hong
Apr 1, 2008·Journal of Evaluation in Clinical Practice·Chinho Lin, Chun-Mei Lin
May 17, 2008·Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration·Li Chang, Jung-Hua Hung
Apr 11, 2012·International Journal of Molecular Sciences·Rahele GhanbariNazamid Saari
Oct 10, 2012·Asian Pacific Journal of Tropical Medicine·Mohammad BaratiAbdoreza Salahi-moghaddam
Jun 23, 2009·Journal of Clinical Nursing·Shu-Fen SuMing-Jen Yang

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