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頁籤選單縮合
題名 | 從「購買醫療服務」到「購買健康」?--氣喘醫療服務改善方案的經濟面評估與病人滿意度調查=From Purchasing Medical Care to Purchasing Health?--Economic Evaluations and Survey of Patient Satisfaction of a Government-Sponsored Disease Management Program for Asthmatics |
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作者 | 翁慧卿; | 書刊名 | 臺灣社會福利學刊 |
卷期 | 3:2 2004.12[民93.12] |
頁次 | 頁37-78 |
分類號 | 419.73 |
關鍵詞 | 氣喘; 醫療服務改善方案; 疾病管理; 論質計酬; 全民健康保險; Asthma; Disease management; Pay by quality; National health insurance; |
語文 | 中文(Chinese) |
中文摘要 | 中央健康保險局於201年11月提出「購買健康」為導向的新理念,推行氣喘等五大疾病的醫療服務改善方案(又稱疾病管理論質計酬方案)。本研究主要探討加入疾病管理試辦計畫的病人在經濟面的改弈。本研究計設計使用健保局的次級資料及病人問卷的初級資料來分析。實驗組之氣喘病人計22,642人,全國對照組病人為551,902。完成年終照護者共1067人,本研究選取完成一年年終照護之舊個案氣喘病人854位進行實驗組前後測醫療費用的檢定,及醫療服務滿意度的調查。共蒐集病人問卷671份。氣喘疾病管理的成效在一年介入後,已有初步正面的效果顯現。醫療資源改變上,第二年較第一年顯著增加的有門診次數(26.1%)、門診費用(41.8%)、總次數(23.4%)與總費用(26.5%)。顯著降低的有急診次數(-34.4%)、急診費用(-31.2%)與住院天數(-35.8%)。住院次數(-11.2%)與住院費用(-25.1%)雖在統計上沒有呈現顯差異,但已有大幅降低的趨勢。有七成以上的病人滿意氣喘的照護、八成以上的病人同意接受治療後,氣喘控制比以前好。 |
英文摘要 | The objective of this study was to investigate the effect of an outpatient-based healthcare quality improvement program for patients with asthma. Using a population-based approach and prospective perspective, total costs and number of vests per member for medical services 1 year before and after entry into this disease management program for enrolled participants were compared during the fiscal year 200, 11 to 2003, 9. Patients who were diagnosed with asthma at least 1 year prior to the implementation of the program were included; all patients were members of Bureau of National Health Insurance in Taiwan. Of the 570,739 patients with asthma, 22,642 (3.97%) patients who were participated this program served as an experimental group. Because of difference time of patient enrollment to this program and high dropout rates (77.34%), only 854 patients completed 1-year follow-up program by 2003,9. The total mean number of visits increased form 11.526 to 14.220 at follow-up. Though the total mean costs (26.5%) and outpatient costs (26.1%) increased, the mean emergency department (ED) visits and hospitalization rates were significantly reduced by 34.4% and 51.74%, respectively, compared to the previous year. The4se findings would be expected if outcome-based disease management were effectively promoting clinically indicated outpatient interventions, thereby avoiding complications that resulted in inpatient admissions and ED utilization as well as higher costs. These results have significance for the design of future programs in the Bureau of National Health Insurance, TAIWAN aimed at improving the care of people with asthma and other chronic diseases. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。