:::

詳目顯示

回上一頁
題名:模擬實施新制DRG(Tw-DRGs)對醫療費用之影響及因應之道--以股骨轉子間骨折(210,211)為例
書刊名:醫務管理期刊
作者:李佳霖方莉李聖瑤蔡桂香韋有升
作者(外文):Lee, Chia-linFang, LiLee, Shang-yaoTsai, Kuei-hsiangWei, Yeou-sheng
出版日期:2009
卷期:10:3
頁次:頁153-164
主題關鍵詞:股骨轉子間骨折新制診斷關係群Femur intertrochanter fractureTw-DRGsIntrochanter fracture of the femurPayment
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(2) 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:2
  • 共同引用共同引用:38
  • 點閱點閱:62
目的:本文在探討推出台灣新制DRG(Taiwan-DRGs)〔以下簡稱新制DRG(Tw-DRGs)〕對醫療費用的影響,在控制使用的骨科耗材費用後,對同樣的疾病但是分屬不同新制DRG(Tw-DRGs)組別進行分析。 方法:在南部一家區域醫院中股骨轉子間骨折之52個案例,以病人年齡、有無併發症或合併症(Complications or Comorbidities)〔以下簡稱CC〕及簡單/複雜診斷以及出院轉歸區分各個組合來分爲Tw-DRGs 210及Tw-DRGs 211兩組來區分給付金額,分出屬於第一組有CC及複雜診斷之Group 1(Tw-DRGs 210)及第二組沒有CC及簡單診斷之Group 2(Tw-DRGs 211)兩組,以SPSS 13.0統計軟體進行統計檢定,以描述性統計分析來說明收案樣本之人口學資料及各種費用,再以配對t檢定及單因子變異數分析進行差異性之檢定。 結果:在實際金額(FFS)、特殊檢查費、住院日數中會因組別不同而有顯著差異。統計全部52例個案,實施新制DRG(Tw-DRGs)前後比較實際費用與DRG支付定額並無顯著差異,而在Group 2 Tw-DRG 211這組實施前後於金額平均數上有差異,DRG實施後於收入金額(健保局所支付定額)較實際費用多。 結論:研究結果顯示,針對股骨轉子間骨折接受手術之患者,實施新制DRG(Tw-DRGs)後,醫療費用無明顯之差異。屬於第二組Group 2 Tw-DRG 211病患,醫院平均會有一萬餘點數的盈餘。而屬於第一組有CC之Group 1(Tw-DRGs 210),醫療費用可能會有超過健保局所支付的DRG定額。
Objective: The purpose of this study was to observe the changes in hospital costs and reimbursements after the introduction of the new diagnosisrelated group (DRG) payment system in Taiwan (Tw-DRGs). Methods: We recruited 52 patients who suffered from intertrochanter fracture of the femur from a regional teaching hospital in southern Taiwan. The patients were divided into two groups for analysis. Those who had more complex diagnoses and complications or comorbid conditions were classified as Group 1 (Tw-DRG 210), and the patients who had a simple diagnosis were classified as Group 2 (Tw-DRG 211). SPSS 13.0 software was used to analyze the data. Descriptive statistics were used to analyze the demographic data and costs. Paired t-tests and one way analysis of variance were used to analyze the differences between groups. Results: Between the two groups, the FFS (Fee for service), the special examination (Computed Tomography and Panendoscopy) and the length of hospital stay were significantly different. The total hospital costs for these patients was not significantly different after the new payment system was introduced, but in Group 2 the hospital payment which the Taiwan's Bureau of National Health Insurance (BNHI) offered was higher than the actual cost and in Group 1 it was lower. Conclusions: The results of this study indicate that the hospital payment from the BNHI was not significantly different from the actual medical costs for the total number of patients with intertrochanter fracture of the femur. The patients who belonged to Group 2 (Tw-DRG 211) usually had lower hospital costs than the payment received from BNHI, but the hospital costs for the patients in Group 1 (Tw-DRG 210) were usually higher than the payment received.
期刊論文
1.宋松遠、張慧如、陳銘樹、錢慶文(20070300)。全民健保家庭醫師整合性照護制度試辦計畫之評估--以花蓮某社區醫療群為例。醫務管理期刊,8(1),51-66。new window  延伸查詢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.賴憲堂、楊志良、范碧玉(19980800)。全民健康保險下疾病分類編碼品質與相關影響因素研究。中華公共衛生雜誌,17(4),337-348。new window  延伸查詢new window
4.韓揆(20050300)。診斷組合制在臺推行問題(上)--DRGs之支付精神,支付邏輯及侷限。醫務管理期刊,6(1),1-19。new window  延伸查詢new window
5.陳怡蒼、林恆慶(20040200)。診斷關係群前瞻性支付制度對醫療品質影響之探討。醫院,37(1),16-26。  延伸查詢new window
6.簡麗年、吳肖琪(20030200)。論病例計酬實施前後全股(髖)關節置換術病患出院後30日內的再住院情形。臺灣公共衛生雜誌,22(1),69-78。new window  延伸查詢new window
其他
1.中央健康保險局(2008)。服務滿意度調査。  延伸查詢new window
2.江秀玲、關皚麗、蕭元哲、黃俊英(2007)。醫師主管對醫院總額管理實務態度之探索性研究。  延伸查詢new window
3.中央健康保險局(2008)。DRGs支付制度。  延伸查詢new window
4.Milbrandt EB, Kersten A, Rahim MT,(2008)。Growth of intensive care unitresource use and its estimated cost in Medicare。  new window
5.江雪萍(2007)。預估Tw-DRG支付制度實施後對醫院經營績效之影響--以某區域醫院爲例。  延伸查詢new window
6.蔡雅慧、黃國哲、宋永魁(2006)。實施「前胎剖腹產之陰道生產」論病例計酬對醫師執行剖腹產後自然產之影響。  延伸查詢new window
7.簡聰健(1994)。診斷關聯群前瞻性支付制度之介紹(下)。  延伸查詢new window
8.王拔群、張燕良、黃麗萍等(2004)。論病例計酬制實施對喉直達鏡顯微手術治療良性喉部病變之影響。  延伸查詢new window
9.吳蕙玲(2007)。美國Medicare嚴重度調整DRGs之主要併發症/合併症於Tw-DRGs分類架構之初探性研究--以四個呼吸系統DRGs爲例。  延伸查詢new window
10.莊世杰、黃維民、林秀美(2002)。台灣全民健保制度下論病例計酬對醫師診療行爲之影響。  延伸查詢new window
11.陳怡蒼、林恆慶(2004)。探討醫師對論病例計酬制度下醫療品質的認知。  延伸查詢new window
12.Miura LN, Dipiero AR, Homer LD.(2009)。Effects of a Geriatrician-Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes。  new window
 
 
 
 
第一頁 上一頁 下一頁 最後一頁 top
:::
無相關書籍
 
無相關著作
 
QR Code
QRCODE