論病例計酬制度對鼻中隔鼻道成形手術病患醫療資源利用之影響－以某區域醫院為例

Effects of Case Payment on Medical Utilization of Septomeatal Plasty Patients: Based on a Regional Hospital

10.7078/TSMHMNJ.200406.0097

莊世杰(Shih-Chieh Chuang)；黃維民(Wei-Min Huang)；林秀美(Hsiu-Mei Lin)；袁本治(Ben-Chih Yuan)

論病例計酬 ； 論量計酬 ； 醫師行為 ； 醫療資源利用 ； case payment ； fee-for-service ； physician behavior ； medical utilization

東港安泰醫護雜誌

10卷2期（2004 / 06 / 01）

97 - 104

繁體中文

背景：自從1995年3月，在台灣實施全民健康保險以來，醫療費用支出逐年上升，於是健保局由支付制度面改革進行成本控制，陸續針對部份醫療處置實施論病例計酬制。至今，論病例計酬制度實施成效對接受鼻中隔鼻道成形術的病患的醫療資源利用研究並不多，因此，本研究乃詴圖探討並分析此制度的實施，對此種手術病患的醫療資源利用是否存在明顯的影響。 方法：針對南部地區某區域教學醫院，接受鼻中隔鼻道成形術之病患，論病例計酬制度實施前後各一年期間，有效樣本數共153名進行研究。研究方法包括描述性分析及平均數差異分析，探討實施前後醫療資源利用之影響。 結果：論病例計酬制度實施後，平均住院日數由5.21日下降為3.51日，降幅為32.6%，具有顯著差異；平均每位病患總醫療費用降低2331元，降幅為8.7%，具有顯著差異；住院至手術執行日數明顯縮短，由1.06日下降為0.35日。 結論：研究發現論病例計酬制度的項目中，鼻中隔鼻道成形術對於該研究醫院具有降低健保住院醫療支出的功能，但支付制度對整體醫療品質的影響範圍廣大，本研究之對象僅有一家區域醫院且並未廣泛探討各項因素，是為本研究之限制。面對健保局未來將擴大此制度實施範圍，建議各醫院及醫師應該改善其財務管理能力，以因應全民健保論病例計酬制度的全面實施。

BACKGROUND: Since 1995 the NHI was implemented in Taiwan, medical expenditure is increasing each year. Hence, NHI Bureau decided to reform the existing reimbursement system, through the case payment system as a way of controlling the expenditures of medical care. Up now, empirical studies on the effect of case payment system in Taiwan are numbered. Therefore the purpose of this study is to analyze the effects of case payment on medical utilization and to examine whether it has an obvious influence on the hospital. METHODS: This study will evaluate the impacts of case payment system on the response of medical utilization. The patients had treated by septomeatal plasty (SMP) at one regional teaching hospital which in south area of Taiwan were studied. The samples include 84 patients before and 69 patients after case payment system was implemented. RESULTS: After case payment system implementation, averaged length of admission was significantly decreased from 5.21 days to 3.51 days. Averaged total medical charges per inpatients were reduced NT 2331 dollars, and the rate of fall about 8.7%. Averaged length of performed surgery after admission was reduced from 1.06 days to 0.35 days. We noted no significant difference about patient choice to case payment system. CONCLUSIONS: We concluded the case payment of spetomeatal plasty as a way of controlling the medical care expenditures in the study hospital. But payment system was affected total medical quality generally. This study showed limitation to discuss each factors obviously. NHI Bureau decided to extend the coverage of the case payment program in the future. It is important for health care providers to increase the financial management responsibility.