Applying lot-by-lot double sampling plan to reform Taiwan National Health Insurance auditing system

Applying lot-by-lot double sampling plan to reform Taiwan National Health Insurance auditing system This paper seeks to design an elaborate and effective “sampling audit and payment process” for a single-payer system of national health insurance. Furthermore, contrive incentive mechanisms in the “sampling audit and payment process” to make the healthcare providers willing to apply for their medical claim payments straightforwardly. A framework of “medical claim payment auditing by double sampling plan (MCPAD)” procedure based on the lot-by-lot double sampling plan was proposed to curb the growth of medical expenses. The proposed procedure entertains several advantages, including: (1) it meets international standards of sampling plan; (2) it simplifies the auditing process; (3) it reduces sample size and auditing costs; and (4) it encourages healthcare providers using an honest medical claim payment through the incentive mechanisms. This study successfully reduces the sampling cost and effectively audits the claimed medical fees as well as encourages healthcare providers to straightforwardly apply for their medical claim payments. Practically, the proposed MCPAD procedure is also applied to healthcare provider. It is anticipated that the proposed procedure in other nations in the future. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Quality & Quantity Springer Journals

Applying lot-by-lot double sampling plan to reform Taiwan National Health Insurance auditing system

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Publisher
Springer Netherlands
Copyright
Copyright © 2007 by Springer Science+Business Media B.V.
Subject
Social Sciences; Methodology of the Social Sciences; Social Sciences, general
ISSN
0033-5177
eISSN
1573-7845
D.O.I.
10.1007/s11135-007-9142-y
Publisher site
See Article on Publisher Site

Abstract

This paper seeks to design an elaborate and effective “sampling audit and payment process” for a single-payer system of national health insurance. Furthermore, contrive incentive mechanisms in the “sampling audit and payment process” to make the healthcare providers willing to apply for their medical claim payments straightforwardly. A framework of “medical claim payment auditing by double sampling plan (MCPAD)” procedure based on the lot-by-lot double sampling plan was proposed to curb the growth of medical expenses. The proposed procedure entertains several advantages, including: (1) it meets international standards of sampling plan; (2) it simplifies the auditing process; (3) it reduces sample size and auditing costs; and (4) it encourages healthcare providers using an honest medical claim payment through the incentive mechanisms. This study successfully reduces the sampling cost and effectively audits the claimed medical fees as well as encourages healthcare providers to straightforwardly apply for their medical claim payments. Practically, the proposed MCPAD procedure is also applied to healthcare provider. It is anticipated that the proposed procedure in other nations in the future.

Journal

Quality & QuantitySpringer Journals

Published: Jan 5, 2008

References

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