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題名 | Relationships between Length of Stay and Hospital Characteristics under the Case-payment System in Taiwan: Using Data for Vaginal Delivery Patients=論病例計酬制度下住院天數與醫院特性關係之研究--以自然生產為例 |
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作者 | 林恆慶; 陳楚杰; 董鈺琪; 湯澡薰; | 書刊名 | 長庚醫學 |
卷期 | 26:4 2003.04[民92.04] |
頁次 | 頁259-268 |
分類號 | 419.45 |
關鍵詞 | 論病例計酬; 住院天數; 自然生產; Case payment; Length of stay; Vaginal delivery; |
語文 | 英文(English) |
中文摘要 | 背景:自臺灣全民健康保險開始就已實施論病例計酬制度,本研究選擇自然生產之病人,探討在論病例計酬制度下住院天數與醫院特性的關係。 方法:本研究使用由國家衛生研究院發行的1999年全民健康保險學術研究資料庫的次級資料,合乎選擇標準的自然生產病人共有5456位。以複迴歸分析以是討住院天數與醫院所有權、醫院層級、醫院所在地及是否為教學醫院之關係。 結果:結果發現在控制病人年齡及有無次診斷後,醫院所有權、醫院層級、和醫院所在地與住院天數有統計上的顯著關係。對自然生產之病人而言,私立醫院病人的住院天數比公立醫院及財團法人醫院短;醫學中心和區域醫院病人的住院天數比地區醫院長;北部醫院病人的住院天數比中部及南部醫院長。 結論:在論病例計酬制度下,住院天數與醫院特性之間確實有關聯性存在,建議中央健康保險局成立類似美國同儕審查組織的機構來監控有不正常住院天數的醫院,以確保病人權益。 |
英文摘要 | Background: Case payment has been implemented since the beginning of Taiwan’s National Health Insurance Program in 1995. This study selected patients undergoing a vaginal delivery to explore the relationships between maternal length of stay (LOS) and hospital characterstics under the case-payment system in Taiwan. Methods: The National Health Insurance Research Database of 1999 from Taiwan’s National Health Research Institutes was used in this study. In total, 5456 patients who underwent a vaginal delivery in 1999 meeting the section criteria were drawn fro the database. A multiple regression analysis was performed in which LOS was regressed against the variables of hospital level, hospital location, hospital location, hospital ownership, and teaching status. Results: The regression model indicated that hospital level, hospital ownership, and hospital location were significantly related to LOS after adjustment for patient age, principal procedure, and the presence of a secondary diagnosis. The LOS for patients undergoing a vaginal delivery in private hospitals was shorter than those in public and non-profit proprietary hospitals. Patients admitted to medical centers or regional hospitals were more likely to have a longer mean LOS in comparison with their counterparts admitted to district hospitals. The LOS for patients hospitalized in northern Taiwan tended to be significantly longer on average than those in central and southern Taiwan. Conclusions: This study demonstrates that wide variations in LOS exist among hospitals in Taiwan under the case-payment system. It is recommended that the Bureau of the National Health Insurance develop a national system to monitor certain hospitals that have an unusually short LOS. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。