Trial Plan with Capitation Payment of the National Healthcare Insurance in Taiwan: Establishing a Loyal Patient Selection Model

Since 2002, the healthcare system in Taiwan has implemented a global budgeting scheme in clinics and hospitals with an expenditure cap. The current mode of payment for medical points in Taiwan is primarily through the fee-for-service (FFS) mechanism. This payment mechanism has diminished the quality of services that clinics and hospitals provide to patients. Furthermore, FFS does not grant incentives that allow providers to invest in preventive healthcare and health promotional activities. Compared with FFS, a payment unit in the capitation mechanism is people rather than the number of patients. That is, the healthier people are, the more reimbursement providers obtain for healthcare. In general, financial risks that confront medical services are primarily assumed by healthcare providers. Therefore, medical teams have to reduce the amount of services and the density of clinical practice, such that the healthcare provider can sustain the quality of medical services. Accordingly, this study develops an approach using stochastic processes with an RFM (Recency, Frequency, Monetary) model is utilized to proceed with the activeness analysis of patients and prognosticate whether patients will remain loyal Therefore, a proper marketing stratagem can be deliberated as a reference for managing the physician–patient relationship; at the same time, this healthcare stratagem is expected to promote the impression of hospitals and enhance management efficiency.