以模糊多準則決策模式建立一般外科手術支付標準

Establishing Reimbursement Standard of General Surgical Procedures by Fuzzy Multiple Criteria Decision Making Model

10.6320/FJM.2005.9(3).03

黃元惠(Yuan-Huei Huang)；張北葉(Pei-Yeh Chang)；洪志洋(Chih-Young Hung)；王貴英(Kuei-Ing Wang)；許楨屏(Chen-Ping Hsu)；張金堅(King-Jen Chang)

全民健保 ； 支付標準 ； 模糊多準則決策法 ； national health insurance ； reimbursement standard ； fuzzy multiple criteria decision making

台灣醫學

9卷3期（2005 / 05 / 01）

323 - 331

繁體中文

目標：全民健保支付標準大多沿用勞保時期之標準，許多項目自民國78年至今，未做合理調整，造成醫學界很大的衝擊。本研究目的為架構手術項目支付標準訂定模型，供政府在做支付標準調整時之參考。方法：本研究主要採用模糊多準則決策法(FMCDM)，來架構新的一般外科手術支付標準訂定之模型，並以一般外科11項手術項目支付標準為例，進行模型之實證分析。結果：FMCDM模型具有三個層級，第一層級為4個評量構面、第二層級為16個評量準則、及第三個層級的11項一般外科手術基準項。依此模型得出新的11項一般外科支付標準相對值，與另外兩組支付標準：健保草案及一般外科專家意見之相對值比較，具有高一致性的Spearman相關係數。結論：本研究結果顯示，FMCDM模型可以有效凝聚一般外科專家的意見，以建立新的支付標準。

Objectives: The reimbursement standards of Taiwan's National Health Insurance (NHI) are followed that of the era of previous Government Employee/Labor Health Insurance. Many items issued from 1989 ere not rationally adjusted. The purpose of this study is to construct a model for establishing a new reimbursement standard of surgical procedures in the NHI program. Methods: The new reimbursement standards of 11 surgical procedures ere obtained from the empirical study of the fuzzy multiple criteria decision making (FMCDM) model. Results: In the FMCDM model, there are 3 aspects, 16 criteria in evaluation of the 11 representative procedures. The relative values of these 11 procedures are the new reimbursement standard, and have high Spearman correlation coefficient while comparing the schemes of the draft of NHI and surgical experts. Conclusions: The results of our study strongly support that the FMCDM model is effectively in establishing the rational new reimbursement standard of the general surgery.