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題 名 | Case Payment and the Adoption of New Technology: An Empirical Study of Cataract Surgery in Taiwan=論病例計酬與新技術引進:臺灣白內障手術的實證研究 |
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作 者 | 黃宗哲; 史麗珠; 莊逸洲; | 書刊名 | 長庚醫學 |
卷 期 | 27:5 2004.05[民93.05] |
頁 次 | 頁327-336 |
分類號 | 410.2、410.2 |
關鍵詞 | 論病例計酬; 新技術引進; 囊外摘除術; 超音波乳化術; Extracapsular cataract extraction; Phacoemulsification; Case payment; Adoption of new technology; |
語 文 | 英文(English) |
中文摘要 | 背景:長庚紀念醫院於1994年3月與公保簽訂白內障手術住院病患採論病例計酬(case payment),而有其他保險或自費病患仍用論量計酬(fee-for-service)。因此,本研究以白內障手術為例,探討醫療費用支付方式由論量計酬轉變為論病例計酬時,對於醫療服務提供者運用新技術行為的影響。 方法:我們用長庚紀念醫院從1993年3月到1995年2月,以囊外摘除術(ECCE-舊技術)或超音波乳化術(phacoemulsification-新技術)進行白內障手術的住院病患資料進行二手資料分析。以邏輯斯迴歸分析不同期(1993.03∼1994.02-階段1 vs. 1994.03∼1995.02-階段2)、不同保險身份別(公保、勞保、農保與自費)之白內障手術病患,使用不同手術方法進行白內障摘除之病患個案數變化情形。 結果:不論何種何險身分別的病患,白內障開刀新新技術比例持續增加(階段1為6.6%上升至階段2的23.6%),即使超音波乳化術的醫療費用遠高於囊外摘除術。更重要的是,公保病患的白內障開刀新技術比例的成長(3.26倍)卻是最慢的。公保給付白內障手術由論量計酬改為論病例計酬,而醫療服務提供者為回應這種支付方式的改變,而減緩使用超音波乳化術來治療具有公保身分別之病患。 結論:由於醫療費用支付方式會誘導醫師改變其族療行為,因此在建立新的醫療費用支付政策時,應該將醫療新技術與成本控制做一併的考量。 |
英文摘要 | Backgorund: Case payment for cataract surgery with Government Employee Insurance (GEI) was implemented at Chang Gung Memorial Hospital (CGMH) in March 1994, and fee-for-service (FFS) was retained for cataract inpatients with or without other health insurance. We examined the impact of this change in the reimbursement policy from FFS to case payment on the health care provider’s practice behavior towards a new emerging technology, using cataract surgery as an example. Methods: Secondary data analysis was performed using 1 year of CGMH data before (period 1, from March 1993 to February 1994) and after (period 2, from Mach 1994 to February 1995) implementing the new policy. Inpatient records for cataract surgery using either extracapsular cataract extraction (ECCE, the old technology) or phacoemulsification (Phaco, the new technology) were included. Logistic regression models were employed to assess how case payment affected the health care provider’s adoption of new technology. Results: The percentage of case treated using the new Phaco technology grew from period 1(6.6%) to period 2 (23.6%) among all 4 study groups, despite Phaco being more expensive than ECCE. More importantly, the increment ratio of Phaco use from periods 1 to 2 was the smallest for GEI patients (3.26-fold) when compared with the other 3 groups (4.16-5.29-fold). Conclusions: both new technology and cost containment strategies should be taken inot account when setting up a reimbursement policy. |
本系統中英文摘要資訊取自各篇刊載內容。