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Open Access Research article

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques

Tsair-Wei Chien12, Ming-Ting Chou3, Wen-Chung Wang4, Li-Shu Tsai2 and Weir-Sen Lin2*

Author Affiliations

1 Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan

2 Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan

3 Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan

4 Assessment Research Center, The Hong Kong Institute of Education, Hong Kong, China

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BMC Medical Research Methodology 2012, 12:67  doi:10.1186/1471-2288-12-67

Published: 15 May 2012



Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system.


A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12 months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan’s year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system.


ICCs were generated for Taiwan’s year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period.


We recommend using the ICC to annually assess a nation’s year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system.