On the Relationships among Nurse Staffing, Inpatient Care Quality, and Hospital Competition under the Global Budget Payment Scheme of Taiwan’s National Health Insurance System: Mixed Frequency VAR Analyses

Background: Time series analyses on the relationship between nurse staffing and inpatient care quality are rare due to inconsistent frequencies of data common observations nurse-staffing (e.g., monthly) indicators quarterly). Methods: In order deal with issue mixed frequency data, this research adopted MF-VAR model explore causal relationships among staffing, quality, hospital competition under global budget payment scheme Taiwan’s healthcare system. Results: Our results identified bi-directional causation patient outcomes one-way Granger causality running reimbursement payments for services. Impulse-response found positive (negative) effects patient-to-nurse ratio adverse (reimbursement payments) in all types hospitals detrimental medical centers regional across a 12-month period. Conclusions: These findings suggest that is an essential determinant both payments. Strategic policies such as direct subsidy accreditation appropriate levels should be implemented mitigate harmful staffing.