實施丙表前，三所群體醫療執業中心急慢病與牙科醫療費用分析

為了明瞭群醫中心牙科與醫科（急慢性病）的疾病分佈，了解其醫療費用的差異，同時比較研究期間，公勞保機關審核醫療給付的方式，我們立意選取三所使用同一套軟體的群體中心，收集民國76年10月1日至77年3月31日共6個月的門診資料，結果發現來診的44859個病例中，以牙科2717例（各6.1%）的每人次平均醫療費用549元最高，而醫科42142個病例(93.9%)的每人次平均醫療費用為323元，其中急性病例為293元，明顯低於慢性病例的361元。群醫中心的每人次平均醫療費用較高的原因，除了牙科費用較高外，群醫中心以照顧中老年人為主是另一原因，由於40歲以上病例占門診所有病例的71.5%，也因此慢性病例佔了41.3%，使得醫療費用增加。若採用勞保機關做為審核標準的每人次平均醫療費用來分析，則每人次平均醫療費用最高為公務人員眷屬保險的368元，其次為農保及退休人員眷屬保險的363元，再其次為勞保的350元及公保的343元，而自費病患每人次平均醫療費用為224元，至於每人次平均醫療費用最低的為榮民，僅有135元，造成偏低的原因和給付費用有直接的關係。至於採用公保機關的審核方法，可以明顯看出三所群醫中中心公勞農保病患的平均醫療費用，無論是急、慢性病或牙科都比自費病患高，當中，又以牙科差距最大。勞保機關的審核是以每人次平均醫療費用的多寡做標準，對於費用較高者，在審核後對所有處方箋採用固定百分比刪除，不容易對有問題的醫師或牙醫師產生制裁效果，反而容易引起彼此間的磨擦。建議採用公保機關的審核方法，將醫療費用分為牙科與醫科兩部份，其中醫科部份再分成急慢性病，則可以馬上針對各科收費過高的部份予以審核，並且急性病的每人次平均醫療費用的免審範圍和私人診所公平處理，相信必可消除不少開業醫師對群醫中心的反彈。

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並列摘要

In order to explore the medical cost in group practice centers we collected patients data in three centers from October 1, 1987 to March 31, 1988. Totally there were 44859 visits. They were grouped into three categories as dental, acute and chronic disease and the number of visits were 2727 (6.1%), 23624 (52.7%) and 18518 (41.3%) respectively. The medical cost per visit of dental disease was NT$549 which was much higher than the one of medical disease (NT$323). As to the chronic and acute disease, the medical cost per visit were NT$361 and NT$293 respectively. It is suggested to supervise the medical cost of dental disease in group practice centers. About the item of the insurance, the highest medical cost per visit was the patients with Government Official's Couple Insurance (NT$368), followed by the patients with Farmer Insurance or Retired Government Official's Couple Insurance (NT$363). The medical cost per visit were NT$355 and NT$343 in the patients with Labor Insurance and Government Official Insurance respectively. The medical cost was NT$224 in the self-reimbursement patients and one of the reasons is the lower percentage of chronic disease. The medical cost in the patients with Labor Insurance or Government Official Insurance was much higher than the one in self-reimbursement patients, not only in the category of dental disease, but also in the categories of acute and chronic disease. It is suggested that the billing system of insurance company should be based on both the medical cost per visit and the categories of acute, chronic and dental disease.

並列關鍵字

group practice center ； chronic disease ； acute disease ； medical cost

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實施丙表前，三所群體醫療執業中心急慢病與牙科醫療費用分析

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