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題名 | 一般外科實施健保DRGs之資料分析與評估=Impacts of DRGs Implementation for General Surgery |
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作者 | 溫義輝; 陳明鎮; 錢才瑋; 王文中; 林美君; Uen, Yih-huei; Chen, Ming-jenn; Chien, Tsair-wei; Wang, Wen-chung; Lin, Mei-chun; |
期刊 | 醫院 |
出版日期 | 20080800 |
卷期 | 41:4 2008.08[民97.08] |
頁次 | 頁23-35 |
分類號 | 419.45 |
語文 | chi |
關鍵詞 | Rasch分析; 診斷關係群; 主要診斷分類; 一般外科; 醫學中心; Rasch analysis; DRGs; MDC; General surgery; Medical center; |
中文摘要 | 健保局計劃於2008年元月起導入臺灣版本的DRGs,本研究以國內醫學中心一般外科住院申報資料86個DRGs為研究對象,探討離群值、單向度構面、醫院類型間DRGs差異功能的交互作用,並揭示在院中提示醫師醫療費用管理模式的建立。 以2004年國家衛生研究院發行之17家醫學中心(分為國立醫院、榮總系列醫院、私立大學醫院及財團法人醫院等4類)健保住院資料庫,對一般外科常用的2個MDC中86個DRGs住院天數30日內DRGs費用高於下限額的出院個案,依健保局公佈的各DRGs支付金額、費用上限固定停損額,分別對費用的低與高各評定為2至0分,以(1)、瞭解離群值認定不同下的收入影響;(2)、觀察各單向度構面內之收入影響;(3)、是否有哪個DRGs呈醫院類型間顯著差異功能的交互作用;(4)、提議以機率原理建置在院中預測費用異常的提示機制。 結果發現:Rasch分析有較合理的離群值處理效果,醫學中心一般外科的DRGs可區分為3個單向度構面且呈顯著性收入影響的差異,少數DRGs呈現醫院類型間差異功能的交互作用,期以機率原理建置在院中提示醫師醫療費用異常的提示系統,對醫師DRGs費用管理提昇其效能。 |
英文摘要 | Bureau of National Health Insurance (BNHI) in Taiwan is planning to implement DRGs payment system in 2008. The impact of DRGs on medical cost-effectiveness has thus threatened hospital management accordingly. In this study we illustrated the experiences of physicians working for the department of general surgery in a hospital, and probed into those frequently-used 86 DRGs to examine whether (1) those high-cost outliers of DRGs should be excluded before analyses, (2) statistically significant differences in reimbursement of DRGs are presented between hospitals and across dischared cases, and (3) any managed approach could be developed for physicians to control medical fees of DRGs when patients still receive cares in a hospital. Data of inpatient reimbursement claims of 17 medical centers were acquired from BNHI in Taiwan in 2004. We collected discharged subjects complied with one of those 86 DRGs in terms of length of stay (LOS) less than 31 and being their MDC 6 or MDC 7. Four types of hospitals (i.e., public university, veterans general, private university and non-profit organizations) were analyzed in responding to differential item functioning (DIF) free. In compliance with the specified paid amount, upper and lower extreme payment of the individual DRGs released by BNHI, we categorized into two 2 thresholds for each DRG so as to examine whether data fit to the Rasch model's requirement of unidimensionality and local independence. The results show that (1) Rasch analysis sufficiently discriminates DRGs outliers much more reasonably and stably than the traditional one, (2) there are 3 types of latent constructs delineating the behaviors of DRGs in general surgery, (3) DIFs are exhibited on several DRGs and some types of hospitals, and (4) a possible mechanism was proposed to physicians for managed controls on medical fees during patient hospitalization. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。