title: Assessing the impact of budget controls on the prescribing behaviours of physicians treating dialysis-dependent patients.
abstract: OBJECTIVE
  This study examined whether outpatient haemodialysis providers changed their treatment practices with the establishment of an outpatient dialysis global budget (ODGB) through analysing the outpatient visits and medication received by those patients.
  
  
  METHODS
  A sample of 4668 observations (patient year) of 1350 haemodialysis with hypertension (HH) patients and 4668 observations of 1436 non-HH (NHH) patients were drawn from the National Health Insurance Research Database over the years from 1999 to 2005. The impact of ODGB on hypertension-related outpatient utilization of HH was estimated using the difference in difference (DID) method and examined in three stages: (1) the fee for service stage, the pre-ODGB (2000), (2) the phase-in stage (2001-2002) and (3) the post-ODGB stage (2003-2005).
  
  
  RESULTS
  ODGB implementation did not affect the number of dialysis visits for HH patients. However, it did lead to a reduction in fees for antihypertension drugs used by haemodialysis facilities. There was an increase of 4.06 visits per patient per year (P < 0.001) in the number of non-dialysis outpatient with antihypertensive drugs visits for HH patients compared with the control group. The total fees for antihypertensive drugs for HH patients increased by New Taiwan Dollars (NT$)13 008 (P < 0.001) per patient per year relative to the control group after the implementation of ODGB.
  
  
  CONCLUSIONS
  As ODGB was implemented, HH patients received fewer antihypertensive drugs during their dialysis visit. In addition, there was an increase in the number of non-dialysis outpatient visits by HH patients as well as increased payment in the drugs associated with their non-dialysis outpatient visits compared with the control group.
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Rm. 639, Zhongzheng Dist., Taipei 10055, Taiwan, rchang@ntu.edu.tw.
authors.forename: Ray-E
authors.initials: RE
authors.lastname: Chang
authors.affiliation: Department of Human Resource, Shin Kong Wu Ho-Su Memorial Hospital, No.95, Wenchang Rd., Shilin Dist., Taipei 11101, Taiwan and.
authors.forename: Ya-Hsing
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Health Service Administration, Sol Price School of Public Policy, University of Southern California, 650 Childs Way MC 0626, Los Angeles, California 90089-0626, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Myrtle
mesh_terms: D000328:Adult; D000368:Aged; D002017:Budgets; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005102:Health Expenditures; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000639:trends; D006435:Renal Dialysis / Q000191:economics*
keywords: Narrow-band global budget; end-stage renal disease; physician prescribing behaviour