Organizing Business Research Papers(16)

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Business Research

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Complex administrative procedures within Taiwans National
Health Insurance (NHI) scheme have led to errors in insurance claims
and much inefficiency. For instance, adhering to all NHI regulations
would require filling out nearly thirty forms, depending on various
commercial demands, e.g., insurance claims, salary readjustment, and
modification of insurers/claimants name.
With subsequent errors made over confusion in filling out
appropriate forms, the NHI staff spends much time in handling errors
and then requesting insurers and claimants to amend erroneous
information.
Despite the enormous amount of administrative time
and costs involved in handling these errors, this growing concern and
its larger implications have not been addressed in previous literature.
The inability to gradually reduce the amount of human
resources involved in handling insurer and claimant errors and simplify
administrative procedures as well as NHI forms will lead not only to
higher operational costs at NHI but eventually higher insurance
premiums.
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Based on the above, we should develop an administrative procedure
for classifying and simplifying forms to pay insurance premiums and file other
insurance-related claims in Taiwans National Health Insurance (NHI) scheme. A
database containing detailed information of NHI insurance holders can also be
accessed while ensuring the confidentiality of such information, thus reducing
administrative costs and the number of personnel involved.
To do so, three insurance claim-related formscan be
developed to reduce the redundancy of the more than thirty existing ones,
thereby reducing data processing significantly. A highly restricted networked-
based system can then be accessed to ensure the confidentiality of NIH
customer data and also reduce the amount of paperwork that insurance holders
must submit.
As anticipated, the proposed administrative procedure can
streamline the process of filing insurance-related claims by simplifying the form
procedure and enable access to relevant customer data on line in an efficient
manner.
Importantly, the proposed procedure can significantly reduce not
only the amount of time to fill out insurance claims, but also postage fees owing
to the ability of the network-based system to accelerate data processing.
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Taiwanese living standards have dramatically risen in recent years, as
evidenced by the availability of consumer goods, pursuit of cultural interests, and strong
health consciousness. Public media emphasis on maintaining ones health and the wide
acceptance of nutritional supplements have pave the way for a health food products
market, which is further promoted by the increasing popularity of genetically modified
foods. The growth in daily consumption of health food products explains why, according
to governmental statistics, medical and healthcare expenditures account for an
increasing share of household consumption in Taiwan and, correspondingly, a rise in the
number of local pharmacies established recently. A recent study on consumer trends in
the health food products sector in Taiwan revealed not only that consumers prefer retail
outlets over direct selling channels, but also that pharmacies are where consumers most
often purchase health food products. While local pharmacies play a vital role in the
islands healthcare system, continuous changes in retail trends, commercial practices
and the national health insurance scheme necessitate that pharmacists should remain
abreast of marketing and promotional strategies to increase revenue profits.
Although the Taiwanese government has implemented separate frameworks
for the medical and pharmaceutical sectors since 1997, the rate of hospital prescription
drugs filled by pharmacies is extremely low. This trend explains why over-the-counter
drug purchases, along with sanitary and other related medical products, have become
major revenue for pharmacies. Local pharmacies have thus adopted a business model of
one-stop shopping in recent years in which customers can purchase a wide array of
medical and health food products.
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Despite the focus of empirical analysis of pharmacies in
business management strategies, orientation of pharmacists on marketing
practices, consumer purchasing behavior and pricing strategies, previous
studies have not developed a forecasting model to help pharmaceutical
managers increase their scope of effectiveness.
The inability to accurately forecast medical and health care
share of household consumption and the number of local pharmacies to be
established makes it nearly impossible for managers to analyze market
competition precisely and develop effective strategies. Unfortunately,
conventional forecast methods rely on large quantities of data to predict
medical and healthcare share of household consumption and the number of
new pharmacies in coming years. When these methods are adopted,
approaches such as line regression analysis and Time Series analysis depend
on a regular pattern of data; however, accumulating such data is extremely
difficult. Although twenty sources of data are available for healthcare
expenditures per household consumption in Taiwan in recent years, only six
sources of statistical data are available up to the present since the Taiwanese
government implemented separate frameworks for the medical and
pharmaceutical sectors.
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Based on the above, we should develop a
feasible forecasting method to estimate the growth of
medical and health care expenditures as well as
pharmaceutical units in Taiwan.
To do so, medical and health care
expenditure-related data during the period 1999 to 2002
can be obtained from the Central Region Office of the
Budget, Accounting and Statistics, Executive Yuan. Data
on pharmaceutical units can then be obtained from the
2003 Annual Report of the Department of Health. Based
on data from those sources, GM (1, N) model of the Grey
theory can be applied for forecasting purposes.
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As anticipated, the proposed forecasting
method can accurately estimate medical and health care
expenditures as well as the number of pharmacies to be
established in Taiwan from 2003 to 2005.
The proposed method can also identify how the medical
and health care share of household consumption is related
to the number of pharmacies.
Results of this study can provide a valuable
reference for both governmental authorities in formulating
policies and pharmaceutical managers in developing
competitive marketing strategies.
Further details can be found at
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