Services and performance comparisons between self-operated and totally outsourced Taiwan public hospital based nursing homes: A case study

Since passed of The Enforcement Rules of Law for Promotion of Private Participation in Infrastructure Projects in 2000, Taiwan's Department of Health has actively promoted outsourcing for a great deal of public services. Many public hospitals implemented the outsourcing policy in the belief that this would reduce costs and increase revenues. As a result, more than half of public hospital based nursing home services were totally outsourced. The purpose of this study is to compare the services provided and performance between self-operated (SO) and totally outsourced (TO) public hospital based skilled nursing facilities. There are 6 nursing homes in this case study, 3 self-operating and 3 totally outsourced. The average number of beds for SO is 93 with almost 100% occupancy. Totally outsourced facilities average 113 beds with around 80% of occupancy rates. SO facilities have higher staff ratios, lower foreign labor employment rates, and higher monthly charges than that for TO nursing homes. In addition, the SO residents are frailer and need more special treatments compared to the TO residents. Furthermore, physicians spent more time and effort in SO vs. TO nursing homes. The study explores qualitative findings to explain differences between these two categories of skilled nursing facility oversight.