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引文資料
題名:
診斷關聯群附加支付的發展與應用
書刊名:
臺灣公共衛生雜誌
作者:
李卓倫
/
洪錦墩
/
陳文意
/
蔡梓鑫
/
紀駿輝
作者(外文):
Lee, Jwo-leun
/
Hung, Chin-tun
/
Chen, Wen-yi
/
Tsai, Tzu-hsin
/
Chi, Chun-huei
出版日期:
2013
卷期:
32:3
頁次:
頁205-219
主題關鍵詞:
診斷關聯群
;
附加支付
;
新興醫療科技
;
健康保險
;
DRGs
;
Add-on payment
;
New medical technology
;
Health insurance
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(
1
) 博士論文(0) 專書(0) 專書論文(0)
排除自我引用:
1
共同引用:0
點閱:196
新興醫療科技通常會先應用在住院病人身上,當新科技已經上市但還未納入健保給付時,這項新科技不會在診斷關聯群的支付名單內,因此醫院比較不願意使用。理想上,經政府核准的新興醫療科技必須先經過醫療科技評估,以確定其用途、療效、及成本效果後才能正式由全民健保給付,但目前在缺乏醫療科技評估機制的情況下,新醫療科技與現有醫療科技的相對優勢,仍處於模糊的階段。在論量計酬支付制度使用新醫療科技通常會讓醫療支出上升,而導入診斷關聯群可能同時減緩醫療費用上漲和新科技的引進速度。這當中最大的挑戰,在如何透過支付制度設計,來達到一方面控制醫療支出,同時也提供足夠的誘因來促進醫療科技進步的雙重目標。本文之主要目標在描述介紹主要工業化國家對於社會健康保險或國民醫療服務為引進新興醫療科技時,在診斷關聯群支付制度上所做的誘因安排,進而提出其對台灣實施診斷關聯群支付制度的政策啟示。本文介紹的國家包括美國、德國、法國、義大利、和英國。這些國家附加支付的共同性包括制度的銜接、強調醫療自主性、以主診斷碼為依據、建構協商公式、及以科技評估為依據(義大利除外)。同時這些國家的制度也在下列方面有差異:以費用控制為目標(德、法、義)、對申請資格的限制(德、法)、以委員會議為審查機構(德、法)、建構醫療科技成本基準(美、德、英)、及強調資訊透明(美、德、英)。由這些國家實施附加支付經驗之分析,本文歸納出附加支付制度對台灣全民健保的重要啟示包括有助於支付制度的銜接、長期醫療費用控制、及控制家戶自付醫療費用占率。此外,為使附加支付制度達成其政策目的,台灣有必要建構醫療科技評估制度,及標準化客觀的醫療成本估算方式。
以文找文
New medical technologies have often been applied to inpatient care; however, when a newmedical technology becomes available in the market but is not yet covered by national healthinsurance, such a technology is excluded from the Diagnosis-Related Group (DRG) list. Consequently,hospitals may be reluctant to use it. Ideally, once a new medical technology is approved by thegovernment, it should undergo a health technology assessment (HTA) to ascertain its applicability,effectiveness, and cost-effectiveness before it is covered by a national health system. At present,however, the lack of HTAs makes the relative advantage of a new medical technology unclear.The adoption and use of a new technology in a fee-for-service payment system usually leads toincreased medical expenditure. This is where the introduction of DRG add-ons plays an importantrole in regulating the rates of adoption of technology and rising expenditures. The major challengein dealing with a new medical technology is how to design a payment system that will achieve thegoal of controlling expenditure while providing adequate incentives for technological improvement.The purpose of this article is to compare how several industrialized nations designed their DRG addonpayment incentives in order to regulate the adoption of new medical technologies by their nationalhealth care systems, and to provide policy implications for Taiwan. We summarized the DRG addonpayment systems implemented in the United States (U.S.), Germany, France, Italy, and the UnitedKingdom (U.K.). Their systems share several common features in that they are consistent with theexisting payment system, emphasize professional autonomy, use primary diagnostic codes as thefoundation, provide formulas for negotiation, and are based on technology assessment (except Italy).There are unique features in some countries, such as an emphasis on cost control (Germany, France andItaly), restrictions on who can apply (Germany and France), setting up review committees (Germanyand France), a cost-based foundation for medical technology (U.S., Germany and U.K.), and anemphasis on transparency (U.S., Germany and U.K.). For Taiwan, the lessons we learned from thesecountries include the importance of DRG add-on payments in providing consistency in the paymentsystem, control of long-term health care costs and control of household out-of-pocket payments forhealth care. In order for DRG add-ons to achieve policy goals, Taiwan needs to establish systems formedical technology assessment and standardized medical cost accounting.
以文找文
期刊論文
1.
Schreyögg, J.、Bäumler, M.、Busse, R.(2009)。Balancing adoption and affordability of medical devices in Europe。Health Policy,92,218-224。
2.
Centers for Medicare and Medicaid Services(2010)。Background on the add-on payments for new medical services and technologies under the IPPS。Federal Register,75,73091-73094。
3.
Lynk, W. J.(2001)。One DRG, one price? The effect of patient condition on price variation within DRG and across hospitals。International Journal of health Care Finance and Economics,1,111-137。
4.
Clyde, A. T.、Bockstedt, L.、Farkas, J. A.、Jackson, C.(2008)。Experience with Medicare’s new technology addon payment program。Health Aff (Millwood),27,1632-1641。
5.
Busse, R.、Nimptsch, U.、Mansky, T.(2009)。Measuring, monitoring, and managing quality in Germany’s hospitals。Health Aff (Millwood),27,294-304。
6.
Schreyögg, J.、Stargardt, T.、Tiemann, O.、Busse, R.(2006)。Methods to determine reimbursement rates for diagnosis related groups (DRG): a comparison of nine European countries。Health Care Manag Sci,9,215-224。
7.
Tarricone, R.、Marchetti, M.、Lamotte, M.、Annemans, L.、de Jong, P.(2004)。What reimbursement for coronary revascularization with drug-eluting stents?。Eur J Health Econ,5,309-316。
8.
Torbica, A.、Fattore, G.(2005)。The “Essential Levels of Care” in Italy: when being explicit serves the devolution of power。Eur J Health Econ,6(Suppl 1),46-52。
9.
Grilli, R.、Taroni, F.(2006)。Managing the introduction of expensive medical procedures: use of a registry。J Health Serv Res Policy,11,89-93。
10.
Marzpcchi, A.、Saia, F.、Piovaccari, G.(2007)。Long-term safety and efficacy of drug-eluting stents: two year results of the REAL (REgistro AngiopLastiche dell’ Emilia Romagna) multicenter registry。Circulation,115,3181-3188。
11.
Green, C.、Baird, R.(2006)。NICE implementation-overcoming the barriers。Hosp Pharmacist,13,95-97。
12.
Chi, C.、Lee, J. L.、Tsai, S. L.、Chen, W. Y.(2008)。Out of pocket payment for medical care under Taiwan’s National Health Insurance system。Health Econ,17,961-975。
會議論文
1.
Fagan, A.(2011)。ICD-9-CM codes and MS-DRG。New Technology Town Hall Meeting。Baltimore, MD:Center for Medicare and Medicaid Services。47870-47997。
學位論文
1.
Bechtel, B.(2010)。The reimbursement and funding of inpatient medicines: a comparative analysis of inpatientdrug-reimbursement-systems in Germany, England (UK) and France from a socio-scientific perspective(博士論文)。Erasmus University Rotterdam,Rotterdam。
圖書
1.
James, B. D.(2010)。DRG Plus: A Comprehensive Guide to Medicare Severity Diagnostic Related Groups。Los Angeles, CA:Practice Management Information Corporation。
2.
梁亞文、李卓倫、紀駿輝、蔡梓鑫、洪錦墩、陳文意(2011)。各國DRG制度下納入新醫療科技之策略與支付對策分析--以若干國家為例。臺北:行政院衛生署中央健康保險局。
延伸查詢
3.
Chilingerian, J.(2008)。Origins of DRGs in the United States: a technical, political and cultural story。The Globalization of Managerial Innovation in Health Care。Cambridge:Cambridge University Press。
4.
Audit Commission. Health National Report(2006)。Payment by Results Assurance Framework: Pilot Results and Recommendations。London:Audit Commission Publishing Team。
5.
Pate, R.(2009)。What is Payment by Results?。London:Hayward Medical Communications。
6.
行政院衛生署(2010)。中華民國98年國民醫療保健支出。臺北:行政院衛生署。
延伸查詢
其他
1.
The Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP)(2001)。Benefits Improvement and Protection Act of 2000 (BIPA), Section 533(b), Final rule 66 FR 46902。
2.
MEDIClever。A shortcut to medical device reimbursement in Germany,http://www.mediclever.com, 2012/07/04。
3.
Martin, T. D.(2012)。Relating diagnosis-related groups: what Germany and the United States can learn from each other about acute-care payment systems,http://works.bepress.com/timothy_martin/6/, 2012/07/04。
4.
Henschke, C.,,Bäumler, M.,Weid, S.,Busse, R.。The German NUB regulation: a gateway for introducing innovative medical devices into the German inpatient reimbursement system?,http://www.mig.tu-berlin.de/fileadmin/a38331600/2009.lectures/Innsbruck_2009.06.22.ch_EHMA.pdf, 2012/07/04。
5.
Quentin, W.。Hospital financing in Germany: the G-DRG system,http://www.mig.tuberlin.de/fileadmin/a38331600/2010.lectures/London_2010.05.25.wq_LSE_NHS_semina.pdf, 2010/05/25。
6.
MEDIClever。A shortcut to medical device reimbursement in France,http://www.mediclever.com, 2012/07/04。
7.
The Haute Autorité de santé(2012)。HAS annual report 2009,http://www.has-sante.fr/portail/ upload/docs/ application/pdf/2011-02/has_rapport_activite_2009_2011-02-25_11-31-57_229.pdf, 2012/07/04。
8.
East of England。The east of England HCD commissioning arrangements for 2009-10,http://www.npc.co.uk/policy/resources/eoe_hcd.doc, 2012/07/04。
9.
Ashwell, S.。2009-10 Pass Through Payments. Attachment 3. Application for a drug or technology development to be reviewed against criteria that define items that may be added to EoE list as ‘considered suitable for Pass Through Payment’,http://www.npc.co.uk/local_decision_making/resources/eoe_appendix3.doc, 2012/07/04。
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