| 摘要: | 研究目的：
總額支付制度是目前許多國家為了有效抑制醫療費用持續上漲所採行的策略之一，而我國全民健康保險於2002年開始實施醫院個別總額，因此本研究旨在探討全民健康保險醫院個別總額對居家照護醫療利用之影響。
研究方法：
本研究利用國家衛生研究院全民健康保險研究資料庫，2001年至2003年共四組合計20萬人之承保抽樣歸人檔，篩選出申報類別為61、65、66、67的居家照護使用者，共計4576人次為本研究的觀察對象。以描述性統計、t檢定、單因子變異數分析、相關性檢定、複迴歸等統計方法，分析醫院總額實施前後居家照護醫療利用情形。
研究結果：
壹、醫院個別總額實施後，居家照護醫療利用次數較醫院個別總額實施前增加，而平均每次居家照護醫療總費用點數則較醫院個別總額實施前減少。
貳、醫院個別總額實施後，居家照護患者門診醫療利用次數、平均每次門診總醫療費用點數、平均每次門診藥費點數皆較醫院個別總額實施前減少，而平均每次門診用藥天數則較醫院個別總額實施前增加。
參、醫院個別總額實施後，居家照護患者之住院醫療利用次數、平均每次急性住院天數、平均每次慢性住院天數、平均每次住院藥費點數、平均每次住院總醫療費用點數皆較醫院總額實施前減少。
結論：
總體而言，提高居家照護醫療利用率，對於居家照護患者的門診、住院醫療利用與費用都達到降低的效果，居家照護患者所減少的醫療利用部分，可提供更多有急性醫療服務需求的病患接受醫療服務，故建議積極推廣居家照護服務政策。
Purpose:
The global budget is one of the strategies adopted by many countries to reduce the hiking medical expenditure. The purpose of this study was to investigate the impact of global budget on the home healthcare utilization.
Methods:
The source of material came from claims data of 4 sets of sampled registry of beneficiaries of National Health Insurance from 2001 to 2003. Registered codes as 61, 65, 66 and 67 were selected. A total of 4,576 persons were identified from the database of 200,000 samples. We used descriptive analysis, t-test, one-way ANOVA, relevant test and multiple linear regressions to analyze the utilization of home healthcare before and after the global budget.
Results:
After the global budget, the utilization of home healthcare increased than before. The mean total expenditure of home health care was less than before.
About OPD condition, after the global budget, the patient visits, mean total medical payment, and mean medication expenditure were less than before. But mean visit days were more than before.
About inpatient condition, after the global budget, the utilization of inpatient healthcare, mean, length of stay (acute or chronic), mean medication expenditure and the mean total medical payment were less than before.
Conclusions:
In conclusion, the elevation of the utilization of home healthcare could reduce the medication and medical payment of outpatient and inpatient. The reduced part could offer the more needs of acute medical service. So, we suggest that the policy of home healthcare service should be more popularize |
