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題名 | 總額支付制度下Tw-DRGs實施前後醫療服務價量影響之初探--以某區域醫院為例=Preliminary Study on the Effect of Tw-DRGs under Global Budget System on the Reimbursement and Volume of Medical Services: Case Study of a Regional Hospital in Southern Taiwan |
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作者 | 盧振鸞; 龔志銘; 彭麗蓉; 嚴玉華; | 書刊名 | 寶建醫護與管理雜誌 |
卷期 | 8:2 2010.12[民99.12] |
頁次 | 頁2-20 |
分類號 | 419.2 |
關鍵詞 | 總額支付制度; 住院診斷關聯群; 財務風險; Global budget system; Diagnosis related groups; Financial risk; |
語文 | 中文(Chinese) |
中文摘要 | 目的:探討Tw-DRGs 支付制度在2010 年1 月公告實施前後,同期及同儕比較醫院住院醫療服務價與量等差異變化情形。方法:以南部某區域醫院2009 年1月至6 月及2010 年1 月至6 月符合健保局公告之2010 年第一期實施之Tw-DRGs住院案件為對象,共計3,528 件。藉由t-test 統計分析MDC、DRG、CMI、診斷數、平均住院日及住院報酬比率變化。結果: Tw-DRGs 支付制度的實施,醫院管理者更加重視健保申報及疾病編碼之正確性,也使得Tw-DRGs 合併症、併發症之案件提高;平均住院日雖有下降,但調幅之空間有限;實際醫療點數(每件)方面,均較區域醫院低,且醫院管控差額空間較區域醫院高。在 MDC5、MDC6、MDC8、MDC12 及部份DRG 等項目,財務風險值呈現達顯著差異 ( p <0.001)。結論:Tw-DRGs 支付制度實施對個案醫院不同系統或科別產生了不同程度的影響,故針對各MDC 及DRG 項目有達顯著及未達顯著之原因,亦需逐一檢討及改善,以因應Tw-DRGs 第二階段之實施,並達醫療服務效率及醫療品質提昇。 |
英文摘要 | Objective: This thesis aims to explore the changes in the prices and volumes of in-patient medical services, as compared to the hospitals of the same category within the same time period, after implementation of the Tw-DRGs payment system in January 2010.Methods: 3,528 inpatient cases qualified for the first stage of 2010 Tw-DRGs payment were collected from January to June in 2009 and 2010. A t-test was conducted to analyze MDC, DRG, CMI, diagnosis numbers, average length of hospital stay, and the ratio of inpatient financial return. Results: Implementation of the Tw-DRGs system prompted the hospital management to pay more attention to filing of insurance claims and the accuracy of disease coding, which also increased the number of complication cases registered under the Tw-DRGs payment system. Although the average length of hospital stay decreased, the range was rather limited. The actual points (per case) gained from medical treatment were lower than the regional hospitals, but the controllable margin by the hospitals was higher than that of the regional hospitals. In MDC5, MDC6, MDC8, MDC12, and part of the DRG categories, the value of financial risk reached the level of significance ( p <0.001). Conclusion: The Tw-DRGs payment system has varied degrees of effect to different hospital systems or medical departments. Therefore, some of the MDC and DRG variables reached the level of significance and some appeared otherwise. We recommend that the causes must be further reviewed and rectified for the second stage implementation to ensure the efficiency and quality of medical services. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。