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| 題名: | 探討論病例計酬與DRGs支付制度實施對於手術麻醉型態與費用之影響(2/2) |
| 作者: | 蔡文正(Tsai,Wen-Chen);龔佩珍(Pei-Tseng Kung);吳世銓(Rick Sai-Chuen Wu);吳憬全;黃光華(Kuang-Hua Huang) |
| 貢獻者: | 公共衛生學院醫務管理學系 |
| 日期: | 2012-07-31 |
| 上傳時間: | 2012-06-15 16:50:42 (UTC+8) |
| 摘要: | 中央健保局為?節?醫?費用，減少財務壓?，於1995?先以2項手術試辦?病?計酬支付制?（Case payments），隨後逐步增加項目，至2009?為止已經有54項?病?計酬項目。健保局於2010?起實施診斷關?群（Diagnosis related groups, DRGs）支付制?，第一?所實施之155項是由最新修訂1,017項Tw-DRGs中，選出目前已實施的?病?計酬54項疾病為主的DRGs項目先?實施。 根據國內外研究顯示，實施?病?計酬後對於醫?品質、醫?費用、醫師?為等均有影響，實施?病?計酬後確實能?低住院日?與醫?資源耗用。但由於國內外對於實施?病?計酬與DRGs支付制?對於手術麻醉醫??用之研究較少。所以本研究主要目的為瞭解實施?病?計酬與DRGs支付制?對於手術麻醉型態與費用之影響，本研究為??期的研究。 第一?主要探討台灣實施?病?計酬對於手術麻醉型態與費用之影響。第一?研究對象主要是1997-2002?有進?本研究所選定8項?病?計酬住院手術之全國病患，分析其手術麻醉型態與麻醉費用，及在?病?計酬前後的差?，並分別探討病患基本特性、疾病史、是否納入?病?計酬、醫?機構特性、手術主治醫師基本特性等與是否採用較?宜手術麻醉型態、麻醉費用是否相關。其次?用?吉斯迴歸分析探討?病?計酬對是否採用較?宜麻醉型態之影響及其他相關因素。最後?用複迴歸分析探討?病?計酬對麻醉費用之影響及其他相關因素。 中央健康保險局於2010?起實施155項DRGs支付制?，因此第二?主要探討台灣實施DRGs支付制?對於手術麻醉型態與費用之影響。研究對象主要以2008-2010?本研究所選擇10項DRGs手術之全國患者，分析其麻醉型態、麻醉費用，以及比較實施DRGs支付制?前後的差?。其次分析病患個人基本特性、疾病史、醫?機構特性及手術主治醫師基本特性等因素與是否採用較?宜手術麻醉型態、麻醉費用是否相關。進一步?用?吉斯迴歸分析探討實施DRGs支付制?對是否採用較?宜麻醉型態之影響及其他相關因素。最後以複迴歸分析探討實施DRGs支付制?對麻醉費用之影響及其他相關因素。本研究藉由分析?病?計酬、DRGs支付制?對於手術麻醉型態及麻醉費用之影響，以瞭解支付制?對於醫?提供者之?為所產生的影響，研究結果將提供衛政單位擬定相關政策之?考。
In order to save the health care expenditure and reduce the financial pressure, Bureau of National Health Insurance (BNHI) implemented the case payment for two items of surgical operations in 1995. The case payment items increased gradually and there were 54 case payment items until 2009. BNHI carries out the diagnosis related groups (DRGs) payment system in 2010. Based on the 54 case payments items, 155 DRG items which were selected from the 1,017 Tw-DRGs items were executed in the first year in Taiwan. According to previous studies, health care quality, health care expenditure and physicians’ behaviors were influenced after the case payment method was implemented. The length of stay in hospital and the utilization of health care resources can be reduced after the case payment was implemented. There were very few researches previously to evaluate the influence of case payment and DRGs payment on utilization of operation anesthesia. For this two-year study, the main objective of this research is to examine the impact of case payment and DRGs on the anesthesia patterns and anesthesia expenditure. In the first year, this research would like to know the influence of case payments on the anesthesia patterns and anesthesia expenditure. The eight selected case payment items from 1997 to 2002 will be analyzed to know the inpatient anesthetic patterns, anesthesia expenditure, and the difference before and after the case payment being implemented. The correlation between anesthetic patterns or anesthesia expenditure and those factors including patients’ characteristics, illness history, case payment or not, hospital characteristics, and attending physicians’ attribute would be tested. Logistic regression analysis and multiple linear regression analysis will be applied to examine the influence of case payment on the anesthetic patterns used and anesthesia expenditure, respectively. Taiwan BNHI carries out 155 DRG items in 2010. This research will investigate the impact of DRGs implementation on anesthesia patterns and expenditure. The 10 selected DRGs operations will be analyzed from 2008 to 2010. The anesthetic patterns and anesthesia expenditure will be examined and to compare the difference before and after the implementation of DRGs. The correlation between anesthetic patterns or anesthesia expenditure and those factors including patients’ characteristics, illness history, case payment or not, hospital characteristics, and attending physicians’ attribute would be analyzed. Logistic regression analysis and multiple linear regression analysis will be performed to investigate the influence of DRGs on the anesthetic patterns used and anesthesia expenditure, respectively. According to this study, the influence of payment system on health care providers’ behaviors can be understood. The results of this research can be the references of health policy decision making for the public health office. |
| 顯示於類別: | [醫務管理學系暨碩士班] 研究計畫
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