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頁籤選單縮合
| 題 名 | 他山之石可以攻錯--DRG制度之國際比較=Comparing DRG Systems and Experiences from OECD Countries and Developing Countries |
|---|---|
| 作 者 | 呂嵐欽; 林慧雯; 張瀞文; 陳俊賢; 朱子斌; 李友專; 邱文達; | 書刊名 | 健康保險雜誌 |
| 卷 期 | 2:1 民94.08 |
| 頁 次 | 頁40-47 |
| 分類號 | 412.56 |
| 關鍵詞 | 診斷關係群; 前瞻性支付制度; 費用控制; Diagnosis related group; DRG; Prospective payment; Cost control; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 中央健康保險局為了舒緩醫療費用上漲之壓力，使醫療提供者能共同分攤成本，自民國84年4月起陸續實施自然產、剖腹產之論病例計酬制度，直至86年10月正式全面開辦，此制度之開辦使得醫院經營面臨更大的考驗。個案醫院在實施論病例計酬後，雖然亦實施臨床路徑，但醫師費給予方式仍與論量計酬時相同，直到民國91年11月個案醫院才開始試辦醫師獎懲制度，期藉由醫師與醫院共同承擔財務風險，達到醫療費用控制及提昇醫療品質的目的。 本研究隨機抽取三項論病例計酬項目作為路研究樣本，探討個案醫院實施醫師獎懲制度前後醫療品質、總醫療費用及各項醫療費用的變化情形。醫師獎懲制度實施前、後之有效樣本共582例，包括實施前288例及實施後294例。以Microsoft Excel套裝統計軟體進行資料分析，以平均值、標準差、中位數等來描述研考對象之變項分布情形及t-test檢定自變項在實施醫師獎懲制度對總醫療費用及各項費用之影響。研究結果顯示，醫院在實施醫師獎徵制度後治療處置費、特殊材料費、藥費及總醫療費用有明顯下降，唯有檢查費在實施醫師獎懲制度後均明顯上升，至於平均住院日及14天再住院率則因臨床路徑實施後已提升至一定之醫療品質水準，故不因本制度實施有所明顯改變。 實施醫師獎懲制度，對醫療費用的控制及醫療品質的提昇有一定的效果，可提供醫院經營管理者研擬經營策略之參考。 |
| 英文摘要 | To ease the pressure of the rising financial burden, in order that medical providers could share the cost jointly, the Bureau of National Health Insurance had implemented the natural birth and cesarean birth of the case payment system in succession since April 1995, and furthermore began the case payment system in October 1997. However, hospitals are facing critical management challenges with the establishment of this system. After implementing the case payment system, the subject hospital in this case, which has also administered clinical care, is still paying the doctors the same amount as the fee for service method. Thus, the subject hospital began a trial physician reward system in November 2002. It is anticipated that, by allowing physicians to share risks equally with the hospital, the goal of controlling medical expenses and elevating medical care quality can be achieved. This study has randomly selected three instances of case payment as research samples in examining the differences in medical care quality, total medical care expense, and individual medical care expenses of the subject hospital before and after the implementation of the physician reward system. The study shows that after implementing the physician reward system, there is an apparent drop in treatment placement fees, special material fees, medication, and the total medical care expense; only the examination fees show an increase after the implementation of the physician reward system. As for the average hospitalization days and the re-hospitalization rate after 14 days, both figures have risen to within standard medical care quality level due to the implementation of clinical care and therefore are not affected by the implementation of the reward system. Although it has not been long since the subject hospital implemented the physician reward system, the existing data has indeed shown a positive result in controlling medical expenses and enhancing medical care quality after the implementation of the system. This example can serve as a guide for other hospitals. |
本系統中英文摘要資訊取自各篇刊載內容。