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    题名: Application of a single sampling plan for auditing medical-claim payments made by Taiwan National Health Insurance
    作者: Fu, Hwai-hui;Tsai, Hsien-tang;Lin, Ching-wei;Wei, Duan
    贡献者: 淡江大學財務金融學系
    关键词: Sampling audit process;Medical-claim payments;Single sampling plan
    日期: 2004-11
    上传时间: 2009-11-30 17:49:51 (UTC+8)
    出版者: Elsevier
    摘要: 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.
    關聯: Health policy 70(2), pp.185-195
    DOI: 10.1016/j.healthpol.2004.02.006
    显示于类别:[財務金融學系暨研究所] 期刊論文

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