Health Policy Spotlight Effects on Critical Time-Sensitive Diseases: Evidence from Taiwan Categorization of Hospital Emergency Capability Policy

Abstract

Objective To investigate the effects of the Categorization of hospital emergency capability (CHEC) policy on critical time-sensitive diseases (CTSDs). Setting CHEC is a policy implemented worldwide to regionalize and guide the dispatch of critical patients to the nearest appropriate hospital. In 2009, Taiwan's CHEC policy was designed to improve the quality of emergent care for CTSDs. Research Design and Participants A nationwide observational quasi-experimental study was conducted to examine the quality of care for CTSD before (2006-2008) and after (2009-2012) the implementation of the CHEC policy. CHEC policy focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. A difference-in-differences estimation was used to assess the impact of the CHEC policy exposure (AIS and STEMI) on clinical practice and outcomes, compared with the unexposed counterfactual of septic shock. We selected diagnosis and treatment guideline adherence process quality measures as primary outcome and medical utilization, upward transfer rate, short-term and long-term mortality as secondary outcomes. Taiwan National Health Insurance 2005 Longitudinal Health Insurance Database contains one million random cases, including time-sensitive disease samples. Results In our cohort of 9,923 cases, refined through 1:1 propensity score matching, 56% were male, mostly older adults. The CHEC policy significantly reduced medical orders and major diagnostic indicators, yet diagnostic fees notably increased. This led to a decrease in mortality rates, ultimately lowering overall medical expenses. Septic shock cases showed marked reductions in both primary diagnosis indicators and medical orders. In contrast, primary treatment indicators for AIS and STEMI rose, supporting the hypothesis of a health policy spotlight effect. Conclusions This study highlights the CHEC policy's dual effects on reducing costs and enhancing patient outcomes. We observed a health policy spotlight effect, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs that have time-based surveillance indicators.