健保資料庫在醫療資源耗用及醫療品質偵測上之功用

Monitoring the Utilization and Quality of Medical Care Using Data Base of National Health Insurance Clients

蘇喜(Syi Su) ； 黃月桂(Yueh-Kuei Huang) ； 李丞華(Cheng-Hua Li) ； 郝宏恕(Hung-Shu Hao) ； 湯靜怡(Ching-I Tang)

《中華公共衛生雜誌》 16卷6期 (1997/12) Pp. 527-537

https://doi.org/10.6288/CJPH1997-16-06-08

摘要

在獨買的保險制度下，健保局握有95%的醫療資訊，作為政策擬定及品管的有效資料。本文係以健保局現有之資料庫，研擬如何抽取所需的數據，加以運算處理作趨勢分析，將台灣醫療界之資源耗用，及醫療品質的現況，匯集成具有意義的管理資訊系統。俾使健保審查，因分析報表的詳盡，能建立醫療品質管理模式，而提昇審查結果之合理性。現今各界關注的問題，不外乎健保實行後，各項相關的資源耗用、醫療費用、以及醫療品質的變化。本文乃透過健保局及中華民國公共衛生學會，所召開之“健保資料庫應用”研討會，凝聚醫管相關專家意見，建議整合各參與醫院、健保局、及衛生署各醫事機構資料庫，而建立品質計畫與定性指標，諸如：資源耗用指標、品質指標、哨兵事件指標、結構指標、過程指標、結果指標、績效指標等，以作為管理政策的參考。

關鍵字

健保資料庫 ； 醫療資源 ； 醫療品質 ； 定性指標

並列摘要

Being under the single buyer insurance system, the National Health Insurance Bureau gathered 95 percent of medical care delivery information How to maximize the utilization information is a key issue faced by governmental officials, scholars, and health industry C.E.O.s. In order to fulfill more efficient and reasonable management system. A forum concerned with the data base utilization had been conducted, this report represent the consensus among scholars of health care administration. Recently, the society tend to pay more attention to the variation of resource consumption, medical costs, and health care quality. The objective of the study intend to establish the fixed indices to entail problems of inequality under the impact of the national health insurance program. Research on the data base of the National Health Insurance Bureau was reviewed in detail. From the results, we suggested that the data base of NHI need to be improved to increase their adjustment and efficiency by following indices such as: Resource Consumption Indicators, Quality Indicators, Sentinel Event Indicators, Outcome Indicators, Structure Indicators, and Performance Indicators.

並列關鍵字

health insurance data bank ； medical resource ； medical quality