查詢結果分析
相關文獻
- 成年人扁桃腺切除手術論病例計酬制實施之影響評估
- 實施論病例計酬制對成人扁桃腺切除手術執行之影響
- 兒童扁桃腺切除手術論病例計酬制實施之影響評估
- 分析全民健保資料庫以探討喉直達鏡手術治療喉部良性病變論病例計酬制實施之影響評估
- 全民健康保險重大傷病患者住院醫療資源使用
- 國軍官兵使用「就診憑證」就診科別及疾病類型分析
- Health Care Utilization after Economic Reform in Mainland China: A Multinomial Logit Approach
- 脊髓損傷病人使用復健醫療資源之預測因子
- 鼻中膈鼻道成形術論病例計酬制實施之影響評估
- The Implications of Malignancy for Adult Patients with Asymmetrical Tonsils
頁籤選單縮合
題名 | 成年人扁桃腺切除手術論病例計酬制實施之影響評估=The Impacts of Case Payment System on the Practice of Adult Tonsillectomy |
---|---|
作者 | 王拔群; 張燕良; 黃麗萍; 龔聖祐; 蕭曉霽; 楊凱婷; 鍾佩雯; | 書刊名 | 慈濟醫學 |
卷期 | 16:4 2004.08[民93.08] |
頁次 | 頁227-234 |
分類號 | 419.45 |
關鍵詞 | 扁桃腺切除手術; 論病例計酬支付制度; 醫療資源使用; Tonsillectomy; Case payment system; Medical resources utilization; |
語文 | 中文(Chinese) |
中文摘要 | 目的:本研究探討論病例計酬制度的實施對成人扁桃腺切除(adult tonsillectomy)在醫療費用、醫療資源使用以及醫療品質等各種層面的影響。材料與方法:研究對象為1998年3月至2000年3月間,在某醫學中心耳鼻喉科,因扁桃腺肥厚或慢性扁桃腺發炎而接受扁桃腺切除手術的病患,共計收入54例資料,其中論量計酬組共29例,論病例計酬組共25例。本研究探討在論量及論病例計酬兩種不同支付制度下醫療資源耗用、醫療費用、及手術預後的差異。研究Fisher’s Exact Test及Mann-Whitney Test進行統計分析。結果:我們發現論病例計酬組其平均住院天數比論量計酬組少0.3天,惟並無統計上之顯著差異。論病例計酬組其口服及注射藥物之處方均較論量計酬組少(P<0.05),但其相差幅度不大(費用相差3%)。在醫療費用方面,論病例計酬組總申報費用減少20.0%,最主要是因為同時包裏申報多種手術情形減少的關係。我們同時發現醫療提供者並沒有將費用轉嫁到術後門診服務。而再手術、再入院、併發症、是否延長住院以及手術預後等醫療品質監測指標值兩組間比較亦未達統計上的顯著差異。結論:論病例計酬的實施能小幅度提昇成年人扁桃腺切除手術的執行效率,其反應於醫師用藥行為的改變。但醫療費用下降的主要原因乃是申報單一化的結果。論病例計酬支付制度對於醫療品質的影響仍需長時間、多層次、大規模的觀察。 |
英文摘要 | Objective: The objectives of this study were to investigate the impact of the case payment system on the practice of adult tonsillectomy. Materials and Methods: A total of 54 adult patients, who had suffered from chronic tonsillitis and who had underwent tonsillectomy at a medical center during the period from March 1998 to March 2000, were enrolled. Surgical outcomes, medical resource utilization, and healthcare costs were compared between the groups of patients who were operated before (29 patients) and after (25 patients) the implementation of the case payment system for tonsillectomy on March 1999. Analyzes were conducted using the Mann-Whiney U test and the Fisher’s exact test. Results: The surgical outcomes were indistinguishable between two group (P>0.05) and although the average length of stay was shorter by 0.3 day, this also was not significant (P>0.05). We found behavior with respect to prescriptions was significantly modified. Both oral and intravenous medications were significantly reduced with a 3% reduction in cost. The total up-front admission costs were reduced by 20% and this mainly stemmed from simplified and unified surgery claims. There was no evidence of a cost shift to outpatient services. The outcomes indicators, such as re-admission, re-operation, complication, and prolonged hospitalization, were indistinguishable between the two groups (P>0.05). Conclusion: The implication of case payment system was shown to be effective and there was an enhancement in the efficiency of adult tonsillectomy; a small part of this was associated with modification of the provider prescription behavior. However, the cost reduction identified in this study mainly stemmed from simplified and unified surgery claims. The impact of the new payment system on the quality of patient care requires further observation. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。