頁籤選單縮合
題 名 | 全民健保物理治療支付之調查研究=A Survey of Physical Therapy Reimbursement in National Health Insurance |
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作 者 | 王瑞瑤; 李雪楨; 李淑貞; 熊嘉玲; 陳麗妃; | 書刊名 | 中華民國物理治療學會雜誌 |
卷 期 | 24:5 1999.09[民88.09] |
頁 次 | 頁32-39 |
分類號 | 419.56 |
關鍵詞 | 支付; 物理治療; 全民健保; Reimbursement; Physical therapy; National health insurance; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究目的為了解全民健保物理治療給付申報、核減及申復情形,及調查對物理 治療支付制度之意見。以問卷方式進行,由健保局所列各級特約醫療院所中有列復健科目或 復健業務之院所, 為問卷寄發對象,共計 169 所,請其由申報物理治療健保業務負責人填 寫問卷,回收 55 份,回收率為 32.5%,其中不清楚健保申報審查程序或標準佔 43.6%,而 有八成不同意專業審查之合理性及適當性,認為健保現行物理治療支付標準有調漲必要者佔 92.7%, 在門診及住院病患治療部份,簡單--中度治療為最常申報之物理治療項目,區域醫 院之核減率較低,在門診中最常被核減之項目為簡單--中度,坦複雜治療則為住院病患治療 中最常被核減之項目,而申復成功率亦以區域醫院較高,以基層院所較低。本研究顯示,目 前健保物理治療給付、審查及申復方面,尚有很大改善空間。 |
英文摘要 | The purpose of the study is to investigate the claim, denial and appeal of rimbursement system of National Health Insurance. Questionaires were mailed to the hospitals and clinics which provided physical therapy services. Fifty-five hospitals/clinics responded to our questionaire. The responding rate was 32.5%. Among the respondents, 24 ( 43.6% ) did not know about the process or the standard of the claim system. Eighty percents did not agree that the professional review is reasonable or feasible. Most of the respondents ( 92.7% ) suggested that the reimbursement of physical therapy should be higher. "Simple to moderate" physical therapy treatment procedures were the most frequently claimed item in both outpatient and inpatient services. The most frequent denied item was "simple to moderate" in outpatient physical therapy department. While the "complicated" treatment was the most frequent reduction item in inpatient physical therapy services. The successful rate for appeal was higher in "area hospital", and was lower in clinics. According to our results, the National Health Insurance should provide better claim, denial and appeal system in the reimbursement of physical therapy services. |
本系統中英文摘要資訊取自各篇刊載內容。