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題 名 | The Impact of Hospital-Base Global Budget on The Medical Resources in An Emergency Department=健保自主管理對急診部門醫療資源的影響 |
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作 者 | 陳維恭; 鍾佑庭; 張耀回; | 書刊名 | 臺灣急診醫學會醫誌 |
卷 期 | 8:1 民95.03 |
頁 次 | 頁1-7 |
分類號 | 419.52 |
關鍵詞 | 急診; 總額預算; 醫院; 保險; 照護品質; Emergency department; Global budget; Hospital; Insurance; Quality of care; |
語 文 | 英文(English) |
中文摘要 | 目的:分析2004年台灣推動新的健康保險制度-自主管理後對急診部門所造成的影響。方法:本研究為一回溯性的分析,資料來源為台灣中部某醫學中心急診,資料分為實施自主管理前(2003年7月1日到12月31日)以及施行自主管理後(2004年7月1日到12月31日)兩個時期。分析內容包括兩個時期的病人量、檢傷、年齡、品質指標項目、健保申報金額以及急診的成本。結果:病人量在自主管理時期增加了18%,檢傷1級及2級病人的候診時間,在自主管理時期分別是平均6.9分鐘(中位數為6.0分鐘)及9.0分鐘(中位數為7.0分鐘),在未實施自主管理時期則分別是平均6.4分鐘(中位數為5.0分鐘)及10.0分鐘(中位數為8.0分鐘),自主管理期間由緊急醫療救護系統、他院或診所轉入均有增加。未看診離院的病人由自主管理前的每月107人增加到自主管理期間的每日147人(p=0.0041)。自主管理期間急診醫護人員的成本明顯增加,而總申報金額也是增加。結論:許多品質的指標顯示自主管理對急診造成顯著的衝擊,政策制定者要注意類似自主管理這種新的制度在推動時對急診的影響,以避免急診照護品質的惡化。 |
英文摘要 | Objective: To analyze the impact of the hospital-based global budget (HBGB), a new national health care insurance program which started in Taiwan in 2004, on an urban emergency department (ED). Method: It was a retrospective observational study using data from an emergency department (ED) of medical center in central Taiwan. Data was categorized into pre-HBGB period (July 1 to Dec 31 in 2003) and HBGB period (July 1 to Dec 31 in 2004). The number of patients, triage, age, items of quality assessment, reimbursement and costs in this ED were compared during the two periods. Result: The total number of ED patients increased 18% in the HBGB period. The average waiting times to see a physician in triage categories 1 and 2 were 6.9 minutes (median 6.0) and 9.0 minutes (median 7.0) in the pre-HBGB period, compared with 6.4 minutes (median 5.0) and 10.0 minutes (median 8.0) in the HBGB period, respectively. The number of transfer-in cases from emergency medical services (EMS), outside hospitals or private clinics was also significantly increased. The average number of 'leave without being seen' cases increased from 107 in the pre-HBGB period to 147 in the HBGB period (p=0.041). The staffing expenses of the ED significantly increased, but there was a concomitant increase in total reimbursement. Conclusion: Several indicators of quality revealed that the HBGB had a significant impact on the ED. Policymakers should pay careful attention to changes in EDs that are brought about by new health care policies such as the HBGB to prevent any deterioration of quality of care in the ED. |
本系統中英文摘要資訊取自各篇刊載內容。