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題名:論病例計酬制度下醫院薪資策略對醫師診療行為之影響:以某區域醫院為例
書刊名:臺灣公共衛生雜誌
作者:許玫玲張維容黃國哲
作者(外文):Sheu, Mei-lingChang, Wei-jungHuang, Kuo-cherh
出版日期:2005
卷期:24:1
頁次:頁12-21
主題關鍵詞:論病例計酬醫師費醫師行為財務誘因醫療資源耗用Case paymentPhysician feePhysician behaviorFinancial incentivesHealth resource utilization
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(3) 博士論文(2) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:3
  • 共同引用共同引用:16
  • 點閱點閱:48
     目標:許多醫院實施以服務量為基礎之醫師費制度,故醫院醫師沒有誘因減少服務密度。本研究分析論病例計酬制度下,當醫院改變醫師費制度,以財務誘因鼓勵醫師節約醫療資源時,醫師如何回應。方法:本研究以一區域醫院為例,分析醫師費制度改變後,八種論病例計酬案件醫療資源利用的變化。資料涵蓋期間為1998到2001年。依變項為住院日數、醫療費用差額(論病例計酬減論量計酬金額)、以及九項醫療費用細項之論量計酬金額。結果:迴歸分析顯示,醫師費制度改變後,四種案件之住院日數減少,包括子宮完全切除術、痔瘡切除術、疝氣手術、前列腺切除術。醫療費用差額方面,除陰道生產與子宮肌瘤切除術外,其餘六種疾病個案之醫療費用差額均增加。醫療費用細項方面,除了闌尾切除之特殊材料費外,每種個案的藥費與特殊材料費都減少,但本研究無法證實醫師是否為了增加其醫師費收入而選擇性地減少醫療服務項目。結論:個案醫院新的醫師費措施的確使醫師減少醫療資源耗用,然而減少程度因不同疾病而有差異。
     Objective: Hospital physicians do not have incentives to decrease the intensity of services because many hospitals have implemented physician fee policies and compensate physicians based on their guantity of services. This study analyzes how hospital doctors respond to a different physician fee policy that gives them incentives to control health care resources under the case payment system. Methods: This study analyzes how health care resource utilization has changed after the implementation of a new physician fee policy for eight case payment procedures at a regional hospital. The data covers the period from 1998 to 2001. Dependent variables include length of stay (LOS), the amount of savings (defined as the difference between the case payment price and fee-for-service (FFS) expenditure), and the FFS expenditures of nine service categories. Results: The regression results show that after the new physician fee policy was implemented, the LOS had decreased for four types of cases: total hysterectomy, hemorrhoidectomy, herniorrhaphy, and prostatectomy; the amounts of savings had increased for all six types of cases with the exception of vaginal delivery and myomectomy. Except for the special materials of appendectomy, the study found that the FFS expenditures for drugs and special materials had decreased across all types of procedures. However, this study could not confirm whether or not physicians decreased services selectively to increase their physician fee income. Conclusion: Physicians have responded to the new physician fee policy by decreasing the utilization of health care resources. However, the extent to which health resources could be reduced varies among different procedures.
期刊論文
1.Rice, T. H.、Labelle, R. J.(1989)。Do Physicians Induce Demand for Medical Services。Journal of Health Politics, Policy and Law,14(3),587-600。  new window
2.張佳琪、黃文鴻(20011200)。健保支付制度對全髖及全膝關節置換手術醫療利用情形之影響。臺灣公共衛生雜誌,20(6),440-450。new window  延伸查詢new window
3.Ellis, R. P.、McGuire, T. G.(1990)。Optimal payment systems for health services。Journal of Health Economics,9(4),375-396。  new window
4.Ellis, Randall P.、McGuire, Thomas G.(1993)。Supply-side and Demand-side Cost Sharing in Health Care。The Journal of Economic Perspectives,7(4),135-151。  new window
5.莊逸洲、陳怡如、史麗珠、陳理(19990600)。全民健保實施陰道分娩論病例計酬制對醫療資源使用方式的影響--以某財團法人醫學中心為例。中華公共衛生雜誌,18(3),181-188。new window  延伸查詢new window
6.莊逸洲、盧成皆、陳理(19970400)。論量計酬與論病例計酬之支付制度對費用結構與品質之影響:以長庚醫院之剖復生產與陰道分娩為例。中華公共衛生雜誌,16(2),149-159。new window  延伸查詢new window
7.Labelle, R. J.、Stoddard, G.、Rice, T.(1994)。A Re-examincation of the Meaning and Importance of Supplier-Induced Demand。Journal of Health Economics,13(3),347-368。  new window
8.錢慶文、黃三桂(2000)。論病例計酬制度對住院日數及醫療費用之影響:以痔瘡切除手術為例。公共衛生,26(4),303-317。  延伸查詢new window
9.吳敬堂、張香蘭、王文彥、侯毓昌(2000)。臨床路徑之介入對「論病例計酬」案件影響之初步探討-以急性闌尾炎為例。醫院:中華民國醫院協會雜誌,33,48-53。  延伸查詢new window
10.張慧朗、黃世聰、謝明里、王大民、崔克宏、賴榮豪(1999)。在論病例計酬制度下對於接受腹股溝疝氣修補術及經尿道前列腺切除術的病人施行臨床路徑可以改善醫療照顧的效率及品質?。長庚醫學,22,400-408。  延伸查詢new window
11.謝生蘭、陳益良、黃宗人、陳百薰、劉宏文、黃旭霖、林芳琴、戴玫瑰(2000)。急性闌尾炎切除術論病例計酬前後其醫療花費及臨床結果之比較。高雄醫學科學雜誌,16(6),293-298。  延伸查詢new window
12.薛亞聖、洪幼珊、湯澡薰、楊志良、王采薇(2002)。臺灣醫院醫師薪資制度調查。醫學教育,6(2),173-184。new window  延伸查詢new window
13.Phelps, C. E.(1986)。Induced Demand - Can We Ever Know Its Extent。Journal of Health Economics,5(4),355-365。  new window
14.Feldman, Roger、Sloan, Frank(1989)。Reply From Feldman and Sloan。Journal of Health Politics, Policy and Law,14(3),621-625。  new window
15.Hemenway, David、Killen, Alice、Cashman, Suzanne B.、Parks, Cindy Lou、Bicknell, William J.(1990)。Physicians' Responses to Financial Incentives - Evidence from a for-Profit Ambulatory Care Center。The New England Journal of Medicine,322,1059-1063。  new window
學位論文
1.洪錫隆(1998)。醫院對健保論病例計酬制度之因應策略,臺北。  延伸查詢new window
2.洪嘉玲(2001)。臺灣地區教學以上醫院因應論病例計酬制度之策略及成效評估,臺北。  延伸查詢new window
3.廖珮茹(2000)。論病例計酬制實施下風險分攤管理對醫療資源耗用影響之研究,桃園。  延伸查詢new window
4.宋霈蓁(2000)。健保支付制度、醫院薪資制度與醫師醫療行為之研究-以股及腹股溝疝氣修補術為例,桃園。  延伸查詢new window
其他
1.行政院衛生署中央健康保險局(2003)。第七部論病例計酬,0。  延伸查詢new window
 
 
 
 
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