臺灣人文及社會科學引文索引資料庫系統

:::

詳目顯示

回上一頁
第 1 筆 / 總合 1 筆   第一頁 上一頁 下一頁 最後一頁
/1頁
題名：模擬DRGs實施對我國醫院的財務衝擊
書刊名：臺灣公共衛生雜誌
作者：陳婉茗／吳肖琪
作者(外文)：Chen, Wan-ming／Wu, Shiao-chi
出版日期：2005
卷期：24:4
頁次：頁306-314
主題關鍵詞：疾病診斷關係群；財務衝擊；醫院；模擬；DRGs；Financial impact；Hospital；Simulation
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(6) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:5
  • 共同引用共同引用:134
  • 點閱點閱:57
　　　　　目標：模擬若住院費用由論量計酬制度改採疾病診斷關係群（diagnosis related group；DRGs）制度，對不同特質醫院財務表現之影響。 方法：以健保局1998年至2002年身份證字號加密的全民健保「住院醫療費用清單明細檔」，利用該局提供之第二代醫療資訊服務系統，轉出DRGs代碼；進而模擬平均每住院人次收益差為平均之各年度各醫院每住院人次在DRGs支付制度費用減去論量計酬制度下之費用（以下簡稱收益差），以廣義估計方程式模式（generalized estimating equation；GEE），探討年度效應、醫院特質（權屬層級別、平均編碼個數、平均住院日數、病例組合指標）、區域特質（縣市別醫療市場競爭程度、人口密度、每萬人口醫師數）與醫院收益差之關聯性。 結果：若住院申報費用由論量計酬改採DRGs支付住院費用時，對地區醫院較有利，其各年整體收益差呈現正值、區域以上醫院則呈負值。就權屬別而言（除2002年未有評鑑等級醫院外），各層級醫院的平均收益差皆為公立高於私立；年度效應達統計上顯著差異，從1999年開始，醫院受益有逐年增加（受益差分別為-406元、-268元、-125元、46元）；而醫院特質中平均編碼個數每增加一個、收益差增加1640元，平均住院日數每增加1天、收益差減少1460元，病例組合指標值每上升1單位、收益差增加5055元。 結論：模擬過去五年住院費用改採DRGs制度，呈現各年度的收益差有逐年改善，這可能與相關單位宣示實施DRGs致產生年度效應有關，而不同特質的醫院其收益差會有不同；建議健保局在全面實施DRGs前應注意DRGs支付制度對不同特質醫院所造成之財務衝擊。
　　　　　Objectives: To simulate the financial impact of different kinds of hospitals after the payment system changed to DRGs from fee-for-service. Methods: Data of inpatients from 1998 to 2002, who had their ID scrambed, were grouped into DRGs by the 2nd version software of medical information service system released from BNHI. The difference in the average revenue of per admission per hospital per year between the DRG and fee-for-service payment system was simulated in this study. The association factors with the difference in revenue, such as the year effect, hospital characteristics (ownership-accreditation, average of coding numbers, average length of stay and case-mix index) and regional characteristics (medical competitive level of county, population density and number of physicians) were investigated by the generalized estimating equation model. Results: If payment system was changed from fee-for-service to DRGs, the difference in revenue was positive for district hospitals every year, but negative for regional hospitals and medical centers. The difference in revenue for all of the public hospitals was more than private hospitals (except the hospitals without accreditation in 2002). The year effect for the difference in revenue was also statistically significant. The difference in revenue went from negative to positive compared to 1998 in the past 4 years (NT$ -406 in 1999, NT$ -268 in 2000, NT$ -125 in 2001 and NT$ 46 in 2002). The difference in revenue was increased NT$ 1640 per coding number added and decreased NT$ 1460 per day of length of stay increased. The difference in revenue was decreased NT$ 5055 per case-mix index increased. Conclusion: When the payment system changed from fee-for-service to DRGs, the difference in revenue became better year by year in this simulated study. This year effect was likely related to the announcement of DRG implemented by BNHI. The financial impact was different for different kinds of hospitals.
期刊論文
1.錢慶文、邱瓊慧(19991200)。醫院因應外在環境變化之能力研究：以闌尾切除術實施論病例計酬制度為例。中華公共衛生雜誌，18(6)，432-444。new window  延伸查詢new window
2.Trinh, H. Q.、Begun, J. W.(1998)。Hospital response to the implementation of prospective payment。Health Serv Manage Res，11，163-173。  new window
3.Robinson, J. C.、Luft, H. S.(1985)。The impact of hospital market structure on patient volume, average length of stay, and the cost of care。J Health Econ，4，333-356。  new window
4.Guterman, S.、Eggers, P. W.、Riley, G.、Greene, T. F.、Terrell, S. A.(1988)。The first 3 years of Medicare prospective payment: an overview。Health Care Financ Rev，9，67-77。  new window
5.Hughes, J. S.、Averill, R. F.、Eisenhandler, J.(2004)。Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management。Med Care，42，81-90。  new window
6.Jones, K. R.(1985)。Predicting hospital charge and stay variation. The role of patient teaching status, controlling for diagnosis-related group, demographic characteristics, and severity of illness。Med Care，23，220-235。  new window
7.Averill, R. F.(1998)。Public dissemination of provider performance comparisons in the United States。Hosp Quart，1，39-41。  new window
8.Feinglass, J.、Holloway, J. J.(1991)。The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature。Medical Care Review，48(1)，91-115。  new window
9.Fetter, R. B.(1984)。Diagnosis related groups: the product of the hospital。Clin Res，32，336-340。  new window
10.Fetter, R. B.、Shin, Y.、Freeman, J. L.、Averill, R. F.、Thompson, J. D.(1980)。Case mix definition by diagnosis-related groups。Med Care，18(suppl 2)，1-53。  new window
11.Guterman, S.、Dobson, A.(1986)。Impact of the Medicare prospective payment system for hospitals。Health Care Financing Review，7，97-114。  new window
12.阮子凌、藍忠孚(19990500)。診斷關聯群在我國之引進與發展。全民健康保險，19，10-13。  延伸查詢new window
13.Voss, G. B.、Limpens, P. G.、Brans-Brabant, L. J.、van Ooij, A.(1997)。Cost-variance analysis by DRGs; a technique for clinical budget analysis。Health Policy，39，153-166。  new window
14.Garnick, D. W.、Luft, H. S.、Robinson, J. C.、Tetreault, J.(1987)。Appropriate measures of hospital market areas。Health Services Research，22(1)，69-89。  new window
15.Williams, D.、Hadley, J.、Pettengill, J.(1992)。Profits, community role, and hospital closure: an urban and rural analysis。Med Care，30，174-187。  new window
16.Cody, M.、Friss, L.、Hawkinson, Z. C.(1995)。Predicting Hospital profitability in short-term general community hospitals。Health Care Management Review，20，77-87。  new window
17.Mark, T. L.、Evans, W. N.、Schur, C. L.、Guterman, S.(1998)。Hospital-physician arrangements and hospital financial performance。Medical Care，36(1)，67-78。  new window
18.韓揆(20010800)。互斥、非互斥？診斷組合(DRGs)分類結構之辨。臺灣公共衛生雜誌，20(4)，259-264。new window  延伸查詢new window
19.Coulam, R. F.、Gaumer, G. L.(1992)。Medicare's prospective payment system: A critical appraisal。Health Care Financing Review，1991(Suppl)，45-77。  new window
研究報告
1.李玉春、楊漢湶(1996)。全民健康保險住院論病例計酬制對醫院醫療行為之影響研究報告。  延伸查詢new window
2.范碧玉、鄭茉莉、黃麗秋(1999)。醫療院所申報住診費用之疾病分類編碼適當性分析 (計畫編號：DOH88-NH-008)。  延伸查詢new window
3.江東亮、文羽苹、謝瓊慧(2001)。醫師與病床供給對醫療費用總額之影響 (計畫編號：DOH89-CA-1003)。  延伸查詢new window
4.黃瑞美、鄭茉莉、林富滿、林秀美、陳琇玲(2002)。建立醫院病例組合指標 (計畫編號：DOH91-NH-1018)。  延伸查詢new window
5.藍忠孚、錢慶文(1991)。省市立醫院生產力之研究--以DEA方法研究醫院生產力之運用。  延伸查詢new window
學位論文
1.于美德(2002)。心導管檢查醫療資源耗用分析(碩士論文)。國立陽明大學。  延伸查詢new window
2.田月枝(2000)。市場競爭對醫療費用的影響--以全膝關節置換術為例(碩士論文)。國立陽明大學。  延伸查詢new window
3.金家玉(2002)。市場競爭對醫院產出表現的影響(碩士論文)。國立陽明大學。  延伸查詢new window
4.余珮琦(2003)。住院醫療服務市場之供給誘發需求現象探討(碩士論文)。國立臺灣大學。  延伸查詢new window
5.張樂心(2004)。不同權屬別醫院之經濟行為研究(博士論文)。國立臺灣大學。  延伸查詢new window
6.陳曉真(2000)。應用地理資訊系統分析全髖關節置換手術醫療利用之市場競爭(碩士論文)。國立陽明大學。  延伸查詢new window
7.郭信智(1992)。勞保門診醫療費用支付制度對醫療供給者診療行為之影響(碩士論文)。國立臺灣大學。  延伸查詢new window
8.邱惠雀(1995)。地區醫院人力資源配置與營運績效之相關研究(碩士論文)。國立陽明大學。  延伸查詢new window
圖書
1.張苙雲(1998)。醫療與社會：醫療社會學的探索。台北：巨流。new window  延伸查詢new window
 
 
 
 
第一頁 上一頁 下一頁 最後一頁 top
:::
無相關著作
 
無相關點閱
 
QR Code
QRCODE

臺灣人文及社會科學引文索引資料庫

目前上線人數：1096（臺灣：1091，外國：5） ／ 本年度總使用人次：1855660 ／ 訪客人次（自102年09月）：67653388
國家圖書館著作權聲明 Copyright © 2013 All rights reserved.
本館地址: 100201臺北市中山南路20號． 本館地圖及交通資訊．
總機：(02)23619132．最佳瀏覽解析度為1024x768以上