健保支付制度對全髖及全膝關置換手術療利用情形之影響

Impact of NHI Payment on Medical Utilization of Total Hip Replacement and Total Knee Replacement

張佳琪(Chia-Chi Chang) ； 黃文鴻(Weng F. Hung)

《台灣公共衛生雜誌》 20卷6期 (2001/12) Pp. 440-450

https://doi.org/10.6288/TJPH2001-20-06-04

摘要

目標：本研究目的在瞭解全髖及全膝關節置換手術之住院日數、醫療費用及診療處置行為；並比較不同支付制度對住院日數、醫療費用、診療處置行為之影響。方法：以全民健保86年11月實施論病例計酬前後半年之全髖及全膝關節置換手術的住院病人為研究對象；以健保總局之住院費用及醫令清單明細檔進行資料分析。結果：1.全臗及全膝關節置換手術之平均住院日數分別為11.4天、12.6天，平均醫總用分別為131,766.8元、150,501.1元，醫令種數分別為81.7種、87.0種醫令使用率分別為510.2 次、570.2次。2.兩手術在住院日數、醫療費用、醫令種類數、醫令使用率等指標上，論病例計酬與論量計酬間幾乎都呈現統計顯著之差異。結論：全髖及全膝關節置換手術之整體住院醫療利用情形，在論病例計酬支付制度實施之後呈現醫療資源耗用下降的情形，且使利用情形、醫師行為更趨一致。

關鍵字

論病例計酬 ； 醫療利用 ； 全髖關節置換手術 ； 全膝關節置換手術 ； 全民健保

並列摘要

Objectives: This study analyzed and compared the length of stay, medical costs, and treatment behavior for total hip replacement (THR) and total knee replacement (TKR) in fee-for service and case payment of the NHI payment system. Methods: As the Bureau of National Health Insurance has implemented the case payment for THR and TKR since November 1997, the study subjects comprised of all THR and TKR patients under NHI coverage during May 1997 to April 1998. Results: The average length of stay in THR/ TKR are 11.4 days and 12.6 days, while the average medical costs are NT$ 131,766.8 and NT$ 150,501.1 respectively. The category quantity of medical order for each replacement are 81.7 and 87.0, and the number of medical orders are 510.2 and 570.2 respectively. The indicators of these two surgeries, such as length of stay, medical costs, category quantity and utility rate of medical order showed a statistically significant difference between fee-far-service and case payment. Conclusions: Medical utilization indicators declined after the case payment implementation for total hip replacement and total knee replacement. It is obvious that medical utilization trends produce a converging effect after the implementation of case payment.

並列關鍵字

Case Payment ； Medical Utilization Total Hip Replacement ； Total Knee Replacement ； National Health Insurance.