Effects of balance billing policy on the technology diffusions and financing disparities in health care

Background: The coverage of health technology in health plan is the leading factor to drive the rising costs of healthcare. To balance adoption and affordability of health technology is the emerging critical health policy concerns in developed and developing countries. In order to balance the technological adoption, patient need, and budgets, the balance billing was first introduced to Taiwan's National Health Insurance (NHI) for reimburse drug-eluting stents (DES) in December 2006. The new policy allows each hospital has its own charge to bill patients for the balance. Although the balance billing promoting technology adoption and diffusions, the patient's financial burden and disparity is immense. Yet, little is known about the effects of balance billing policy on technology diffusions and financing disparities in health care system.

Objectives: The aim of this study is to examine the pathways of health technology diffusion, variation and disparity in financial burden of out-of-pocket (OOP) health care expenditures among hospitals in drug-eluting stent use.

Methods: This longitudinal study used National Health Insurance (NHI) claim data to assess health technology diffusion and financing disparity among adult patients (age 20 to 85 years) treated with percutaneous coronary intervention (PCI) between 2007 and 2009. Multilevel analysis was used to assess the effect of the balance billing policy while controlling for patient, physician, and hospital characteristics.

Results: The results showed a wide range level of DES use and OOP payment among hospitals. The patients who treated by academic medical center or located in city hospital are more likely to receive the DES procedure. The patients who treated by private region/community or located in rural hospital more likely pay the double OOP for the balance. In addition, results also revealed that the pathway of DES diffusion was from academic medical center and region hospital then to community hospital.

Conclusions: More than 25% patients received the DES procedure for 3 years after the policy is implemented. The balance billing policy speeds the diffusion of health technology and control the expenditures growth in Taiwan's NHI. However, the free market pricing without any limited for hospital to bill patients for the balance fostered the issue of financing disparities and increase the financial burden for society.