Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques (BMC Medical Research Methodology)

Background: Few studies discuss the indicators used to assess the effect on cost containment in healthcareacross hospitals in a single-payer national healthcare system with constrained medicalresources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwanconstrained hospital-provided medical services in such a system. Methods: A custom Excel-VBA routine to record the distances of standard deviations (SDs) from thecentral line (the mean over the previous 12 months) of a control chart was used to constructand scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals inTaiwan to generate the ICC. The ICC was then used to evaluate Taiwan`s year-basedconvergent power to remain unchanged in hospital-provided constrained medical services. Abubble chart of SDs for a specific month was generated to present the effects of using controlcharts in a national healthcare system. Results: ICCs were generated for Taiwan`s year-based convergent power to constrain its medicalservices from 2000 to 2009. All hospital groups showed a gradually well-controlled supply ofservices that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals thatrequired investigation of possible excessive reimbursements in a specific time period. Conclusion: We recommend using the ICC to annually assess a nation`s year-based convergent power toconstrain medical services across hospitals. Using sequential control charts to regularlymonitor hospital reimbursements is required to achieve financial control in a single-payernationwide healthcare system.