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題名:醫院總額支付制度實施前後對固定醫院就醫病患醫療利用比較之研究
書刊名:醫務管理期刊
作者:陳素珊葉玲玲 引用關係黃光華 引用關係鄭文輝 引用關係
作者(外文):Chen, Su-shanYeh, Ling-lingHuang, Kuang-huaCheng, Wen-hui
出版日期:2008
卷期:9:1
頁次:頁53-65
主題關鍵詞:醫院總額支付制度醫療利用Hospital global budget payment systemMedical 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(0) 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:0
  • 共同引用共同引用:11
  • 點閱點閱:19
目的:本研究主要探討只在醫院就醫病患在醫院總額實施前後之醫療利用的變化,期待研究結果可作爲總額支付制度醫療資源分配之參考。 方法:研究對象爲醫院總額實施前二年只在醫院就醫病患,共4,043位。門住診醫療利用資料收集期間爲2000年7月至2004年6月,以每半年爲一期進行醫療利用分析比較,共分八期。 結果:醫院總額實施後病患各項住診醫療利用每半年成長幅度較實施前增加5.6%~18.2%,醫院部門門診次數成長幅度減少1.0%,門診醫療服務點數增加0.4%。病患在醫院部門每半年的門診次數雖較實施前減少0.05~0.69次,但如果包括基層診所門診就醫次數,則每位病患之平均總門診次數則增加0.05~1.09次。 結論:病患在醫院部門門診就醫次數減少,但總門診就醫次數並未減少。門診醫療利用似乎從醫院部門移至基層診所,需進一步探討轉至基層診所就醫之病患並不是嚴重病患。政府也值得再審現劃分醫院與基層爲兩個總額的議題。
Objectives: This study aims to investigate the changes in medical utilization of those who sought medical care services only in hospital sector after the implementation of Hospital Global budget payment System; thus, the implications for improving healthcare resources allocation can be derived. Methods: The study included 4043 subjects who sought medical care only in hospital sector during the period of two years prior to the implementation of Hospital Global Budget Payment System in July 2002. The data of their utilizing ambulatory and inpatient services in the period of July 2000 to June 2004 which are divided into eight sub-periods of half a year are analyzed. Results: Two major findings are as following: (1) The utilization of inpatient services in per half a year sub-periods after the implementation of Hospital Global Budget Payment System has increased by 5.6-18.2%, while the number of ambulatory visits and the claimed points of outpatient services in hospital sector decreased by 1.0 and 0.4%, respectively. (2) Though the number of ambulatory visits in hospital sector has decreased by 0.05-0.69 visits, the total visits including both clinics and hospitals still increased by 0.05-1.09 visits. Conclusions: Though ambulatory utilization of the patients has decreased in hospital sector after the implementation of Hospital Global Budget Payment System, the total outpatient visits including clinics and hospitals still increased. It seems to show that the patients shifted from hospitals to clinics. However, it needs further investigation to see if the transferred patients were in less severe conditions. Moreover, the relevance of separating the hospital and clinic global budgets deserves review.
Other
1.全民健康保險醫療費用協定委員會(2003)。全民健康保險醫療費用總額支付制度問答輯。  延伸查詢new window
期刊論文
1.莊逸洲、黃崇哲、鄭明智(20030900)。臺灣醫院總額支付制度運作模式的初步探討。醫務管理期刊,4(3),1-17。new window  延伸查詢new window
2.張益誠、廖宏恩(20021000)。西醫基層診所實施總額預算前後之價量變化--以臺灣北部地區西醫基層診所為例。臺灣公共衛生雜誌,21(5),363-372。new window  延伸查詢new window
學位論文
1.邱俊傑(2003)。西醫基層總額預算制度對高雄市診所醫師醫療行為及其經營策略與滿意度之影響(碩士論文)。高雄醫學大學。  延伸查詢new window
其他
1.Horn SD; Sharkey PD(1983)。Measuring severity of illness to predict patient resource use within DRGs。  new window
2.蕭秀如(1999)。牙科總額支付制度試辦計劃效果之初探--以中央健康保險局台北分局轄區範圍內之牙科醫療院所爲例。  延伸查詢new window
3.謝慧貞(2003)。總額預算支付制度對牙醫師醫療行爲影響之研究。  延伸查詢new window
4.陳薇鸚(2003)。基層診所因應西醫基層總額預算支付制度之申報行爲改變--以桃竹苗地區急性上呼吸道感染爲例。  延伸查詢new window
5.馮玉女(2004)。醫院總額支付制度實施前後各級醫院醫療服務之研究--以桃竹苗地區之醫院爲對象。  延伸查詢new window
6.江心怡、張又文、黃清郁、王基騰(2005)。醫院總額制度實施前後醫院與保險人行爲改變之探討。  延伸查詢new window
7.全民健康保險醫療費用協定委員會。全民健康保險醫療費用協定委員會歷次委員會議紀錄。  延伸查詢new window
 
 
 
 
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