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題 名 | Comparison of Appendectomy Medical Expense and Clinical Outcome between Fee for Service and Prospective Payment System=急性闌尾炎切除術論病例計酬前後其醫療花費及臨床結果之比較 |
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作 者 | 陳百薰; 劉宏文; 黃旭霖; 林芳琴; 戴玫瑰; 謝生蘭; 陳益良; 黃宗人; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 16:6 2000.06[民89.06] |
頁 次 | 頁293-298 |
分類號 | 419.45 |
關鍵詞 | 急性闌尾炎切除術; 論病例計酬; 醫療花費; 臨床結果; Perspective payment system; Fee for service; Appendectomy; |
語 文 | 英文(English) |
中文摘要 | 我國自民國84年3月1日實施全民健康保險以來,由於醫療支出不斷 增加,於民國86年10月增加闌尾切除術等九項目試行「論病例計酬」。本研究 之目的即以闌尾切除術為例,比較論病例計酬支付制度實施前後對醫學中心此類 病患住院天數、總住院總費用等項目之差異,以及臨床結果有否改變。本研究收 集南部某醫學中心自民國86年4月1日至同年9月30日連續性所有接受闌尾切 除術之論量計酬有效個案100例,及自86年10月 1日至87年3月3 1日連續 性所有闌尾切除術之論病例計酬有效個案99例。以回溯性方法由病歷收集並分 析病患性別、年齡、住院日數、手術時間、麻醉方法、出院後回門診追蹤次數及 這些病例申報金額之各項費用。研究結果顯示:住院日數及手術時間在論病例計 酬者均較論量計酬者統計學上有意義的減少(兩者 p < 0.01),而住院總費用、病 房費、處置費、藥費、檢查費及麻醉費,論病例計酬者亦均較論量計酬者低(除 麻醉費p < 0.05外,其餘項目 p < 0.01)。論病例計酬及論量計酬其總住院金額與 住院日數、手術時間、病房費、治療處置費、藥費、檢查費及麻醉費均呈正性相 關(所有p < 0.01)。論病例計酬者其住院日數亦與手術時間成正性相關(所有p < 0.01)。論病例計酬實施後相關醫療品質中的臨床結果,本研究以電話追蹤出院患 者 ,得到論量計酬有效例 73 例及論病例計酬有效例 73 例 ,結果顯示:出院 時傷口仍痛、傷口已乾、拆線地點在該醫學中心比例,在論量計酬者與論病例計 酬者均無有意義之差異 (所有p > 0.05) ,而二者在手術後第幾天拆線及手術後 第幾天回復正常工作上亦均無統計學上有意義之差異(兩者p > 0.05)。本研究結 論是論病例計酬支付制度之實施的確可降低住院天數及總住院費用,但其臨床結 果顯示也無差異 。 |
英文摘要 | Since the introduction of national health insurance on March 1st 1995 in Taiwan, another 9 items (including appendectomy) were introduced into the Taiwan /prospective payment system (T/PPS). The modified T/PPS was based on those complicated appendectomy cases with secondary diagnosis or second operation where a total fee over 37,500 New Taiwan (NT) dollars was paid by National Health Insurance Bureau (NHIB) according to the real cost. The T/PPS was implemented in October 1997 due to the continuously increasing financial burden of medical expenses on the NHIB. The purpose of this study is (1) to compare the length of stay (LOS) and total medical expense of appendectomy of fee for service (FFS) and T/PPS and (2) to compare the clinical outcome of wound healing after discharge of the two systems by telephone interview. Our study investigated 100 consecutive appendectomy cases under FFS payment system and 99 consecutive appendectomy cases under T/PPS. We retrospectively analyzed LOS, operation time, and hospital cost of different items through chart review and computer data. Our results revealed that the LOS and operation time of T/PPS were significantly shorter than those of FFS (both p < 0.01). The total hospital cost, fee for room service, treatment, pharmacy, examination and anesthesia in T/PPS were also significantly less than those in FFS (all p < 0.01, except for anesthesia p < 0.05). There existed positive correlation between total hospital cost and LOS, operation time, fee for room service, treatment, pharmacy, examination and anesthesia both for T/PPS and FFS. To evaluate the clinical outcome of appendectomy between T/PPS and FFS, we interviewed 73 T/PPS cases and 73 FFS cases by telephone and chart review. Our results revealed that there were no significant differences in frequencies of having painful incision, clear incision wound on the day of discharge, and removal of stitches at hospital (p all > 0.05). We concluded that compared to FFS, T/PPS can decrease LOS and total hospital cost of appendectomy, and T/PPS, s clinical outcome of appendectomy in T/PPS showed no significant difference from that in FFS. |
本系統中英文摘要資訊取自各篇刊載內容。