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題名 | 北區全民健康保險後復健醫療費用成長分析研究=Growth Analysis for Cost of Rehabilitation Service Under the National Health Insurance Program in Taiwan |
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作者 | 高木榮; 蔡美文; 林茂榮; 林銘川; 王亭貴; 賴金鑫; | 書刊名 | 復健醫學會雜誌 |
卷期 | 27:2 1999.06[民88.06] |
頁次 | 頁37-45 |
分類號 | 419.45 |
關鍵詞 | 復健; 醫療費用; 全民健康保險; Rehabilitation; Medical cost; National health insurance; |
語文 | 中文(Chinese) |
中文摘要 | 全民健保實施後,復健醫療費用支出成長迅速,為有效控制費用成長,減少不必 要的資源浪費,遂分析復健費用結構及其成長,以便擬定控制費用之方案。本研究收集86 年1月至87年6月健保局某分局門診及住院的復健治療費用的申報資料,依醫院評鑑級別 及科別進行治療人次及費用的統計分析,並分三時段來比較。研究結果發現:門診復健治療 總人次佔90.62至92.12%,而門診總費用佔86.97至88.07%。各級院所每個月平均每人次 費用大致平穩。診所平均費用下降,醫學中心平均費用最高。門診物理治療及職能治療醫令 中度項目最多,複雜醫令在醫學中心較高,而住院則以複雜項目最多;門診語言治療複雜項 目為主。住院評估的比例較高,醫學中心的評估較多。在87年1~6月,診所之物理治療醫 令,簡單中度降低,而中度中度增加;診所之職能治療複雜醫令增加。骨科成長最明顯,其 他相關科及非相關科成長也很可觀,只有復健科成長最少,費用及人次均小於10%。和86 年全年比較,87年1~6月的物理治療醫令申報人次增加16.57%,職能治療增加28.89%,若 不含副木則增加29.8%,而語言治療則減少1.03%。各級醫療院所中,以診所人次成長趨勢 較明顯,復健科門診復健治療人次成長趨勢較平緩,而骨科成長趨勢則呈陡峭曲線上升。本 研究的結論為:(1)復健醫療資源的耗用主要在門診,因此復健治療費用控制應由門診著手; (2)以費用控制的觀點,復健科本身申報費用及人次的成長在10%以下,反觀其他相關科的 成長在43%至92%,因此費用的控制,應由減少復健處方提供點著手,開放申報復健治療 的科別不應再增加,以免醫療需求不斷的增加;(3)健保局應管制不合法的申報,疑似不合 理申報及醫令申報錯誤以減少支出。(中華復健醫誌1999; 27(2):37-45) |
英文摘要 | This study analyzes the structure and trends of costs associated with rehabilitation services under the National Health Insurance program. Statistical analysis was performed for costs associated with in-patient and out-patient rehabilitation services in northern Taiwan. 86.97% to 88.07% of total six-month costs were declared for out-patients. Most of the moderate items for physical therapy and occupational therapy were prescribed for out-patients. In contrast, most of the complicated items for physical therapy, occupational therapy and speech therapy were done for in-patients, especially at medical centers. Comparing the period from January to June of 1998 with the same period of 1997, six-month prescriptions increased 16.57% and 28.89% for physical therapy and occupational therapy, respectively; however, those same prescriptions for speech therapy decreased 1.03%. In sum, cost of rehabilitation services increased over the past two years. A majority of the increases were found at LMD clinics, particularly at orthopedic clinics. However, the rehabilitation department had less than a 10% increase in total costs. (J Rehab Med Assoc ROC 1999; 27(2):37-45) |
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