美國RB-RVS（醫療資源基準相對價值表）在長庚醫院之應用

Application of Resource Based-Relative Value Scale (RB-RVS) in Chang Gung Memorial Hospital

莊逸洲(Yih-Jou Juang)

《中華民國公共衛生學會雜誌》 11卷4期 (1992/12) Pp. 357-365

https://doi.org/10.6288/JNPHARC1992-11-04-09

摘要

根據美國HCFA(Health Care Financing Administration)的統計資料顯示在1990年美國全國醫療費用總支出已高達6,613億美元，佔同年度國民總生產毛額(GNP)的12.2%；其中單就『醫師費』部份即已支出1,375億美元，佔總醫療費用的20.8%且『醫師費』在過去十幾年來幾平均以兩倍於GNP成長的速度在增加。面對如此龐大而快速成長的支出，如何訂定『醫師費』的計算基準，以合理的分配醫療資源及反應醫師的付出，在美國近些年來一直是一個非常重要而迫切的研究課題，RB-RVS（醫療資源基準相對價值表）即是在此背景下因應而生並於1992年1月率先於老人健康保險(Medicare)實施。長慶醫院係國內首先實施『醫師費』制度的醫院，近十年來對『醫師費』的計算基準雖亦不斷地檢討改善，惟仍感未盡完善，故美國在研究RB-RVS之初長庚即予引入並陸續實施。本文僅就對RBRVS之瞭解及在長慶應用初期之經驗作一概述，未來是否能全面適用於國內的醫療體系，仍須作更進一步的探討。

並列摘要

According to the statistical data released by HCFA (Health Care Financing Administration) of the United States, the total health care expenditure reached 661.3 billions, or 12.2% of GNP, in 1990. The total expenditure on physician services in 1990 was 137.5 billions, or 20.8 % of the total health care expenditure. In addition, the growth rate of physician fees is almost twice as high as that of GNP in the past of more than 10 years. How to calculate physician fees, based on the reasonable allocation of health resource & the reflection of physicians’ time & workload, is becoming a very important & urgent issue in the United States recently while facing a rapid growth expenditure of physician services. The resource based-relative value scale (RB-RVS) was developed and applied to Medicare in January, 1992 because of those reasons. Chang Gung Memorial Hospital is still not satisfied with its continuous improvement on physician fees system although it implemented physician fees earliest in Taiwan. Chang Gung Memorial Hospital implemented the RB-RVS gradually when the research of RB-RVS was completed. This article will make an introduction to RBRVS's results & preliminary imple-mentation results of Chang Gung Memorial Hospital. It is still not clear whether the health care in Taiwan can implement RB-RVS or not.

並列關鍵字

RBRVS resource-based relative value scale ； RPC relative practice cost ； AST amortization for special training ； CPT-4 current procedure terminology-4