The implementation of National Health Insurance has already been in effect for seven years, and people have begun to demand high quality medical care. The Bureau of National Health Insurance also made quality assurance its first priority of the year. The purpose of this paper is to introduce the evolution of quality review programs, adopted by Center for Medicare & Medicaid (CMS), for Medicare beneficiaries. Meanwhile, the introduction of quality review programs evolution provides possible thoughts about applicable methods of quality assurance for Taiwan's health industry. The United States initiated Medicare and Medicaid programs in 1965; however, medical expenditures for Medicare and Medicaid doubled and quadrupled the first few years after their inceptions. Professional standards review organizations (PSORs) were established in 1972 by amendment of the Social Security Act. The PSORs were established to contain medical expenditure and simultaneously ensure the quality of care provided beneficiaries. Afterward, the Peer Review Organizations (PROs) was established to replace PSORs. The PRO's major mission was reviewing the appropriateness and necessity of medical care provided beneficiaries. CMS also began the Health Care Quality Improvement Initiative (HCQII) program in 1992. The CCQII moved from concentrating on individual clinical errors to analyzing patterns of care and results. The PRO's implementation has ensured both the appropriateness and necessity of medical care provided Medicare beneficiaries. It has also motivated managed care to elevate the quality of care to remain competitive in the health industry. The author suggests developing a quality-monitoring organization organization such as PRO to assure quality medical care is provided to people in Taiwan.
|Translated title of the contribution||The Evolution of Quality Review Programs for Medicare|
|Original language||Traditional Chinese|
|Number of pages||7|
|Publication status||Published - 2002|