全民健保實施後急性病床住院病患超長住院情形之分析

Analysis of Overstay in Acute Beds in Hospitals under the National Health Insurance Program in Taiwan

吳肖琪(Shiao-Chi Wu) ； 林麗嬋(Li-Chan Lin) ； 藍忠孚(Lan-Chung Fu) ； 吳義勇(Yee-Yung Ng)

《中華公共衛生雜誌》 17卷2期 (1998/04) Pp. 139-147

https://doi.org/10.6288/CJPH1998-17-02-07

摘要

全民健保實施後，陸續有些醫院反應急性病床一床難求，部份慢性病患佔用急性病床。為能瞭解此一情形，本研究以全民健保84年7至12月急性病床住院中報資料進行分析，以住院超過30日定義為超長住院，則超長住院息者的比率為4.0%，超長住院人日佔總住院人日24.4%，若能避免超過30日的住院，則估計可空出10.1%之病床，估計此部份費用佔健保住院費用13.1%。以公私立別區分，公立醫院超長住院率7.5%遠較私立27%高，公立超長住院人日為35.1%，和立為18.2%。以層級別區分，醫院層級愈高超長住院愈嚴重，公立與和立醫學中心的超長住院率分別為8.9%與5.6%；其超長住院人日分別為39.6%與27.9%。依專科別區分，內科病床超長部份利用率10.4%，雖遠較復健科32.9%為低，但由於內科病患最多，故超長住院人次居最冠。由前述分析，可以發現超長住院是迫切需要被正視的問題，建議未來應朝落實出院計畫、鼓勵驕展各類長期照護服務、提高住院部份負擔比例、拉大醫院層級部份負擔差距、提高自行負擔金額上限等方向努力。

關鍵字

健康保險 ； 住院日 ； 醫療服務利用 ； 住院病患 ； 佔床情形

並列摘要

Following implementation of Taiwan's National Health Insurance (NHI) some hospitals have reported a shortage of acute beds as a result of long hospital stays by some patients. To study this situation, we analyzed inpatient data (n=930, 751) in acute hospitals covered by NHI from July-December, 1995. Overstay was defined as a hospital stay of over 30 days. The overstay rate was 4.0%. The days of care taken by overstay patients accounted for 24.4% of all days of care in the hospital. Thus, if overstay could be prevented, NHI could conserve 10.1% of total hospital beds and 13.1% of inpatient expenditures. Overstay has different effects in public and private hospitals; the overstay rate in public hospitals exceeded that in private hospitals (7.5% vs. 2.7%). The days of care for overstay patients in public and private hospitals were 35.1% and 18.2% of all days of care, respectively. Differences were also found by rating level of accredited hospitals-those with higher ratings had higher overstay rates. Overstay in medical centers also differed by the nature of the center; the overstay rate for public and private medical centers was 8.9% and 5.6%, respectively. For days of care for overstay patients, again, public outweighs private at 39.6% vs. 27.9% of all days of care. Although the occupancy rate of acute beds for patients in internal medicine is significantly lower than rehabilitation medicine (10.4% vs. 32.9%), the number of occupied acute beds is higher because there are more patients in internal medicine. We recommend that in order to effectuate discharge planning, the government and hospitals develop a long term care delivery system and raise inpatient co-payments.

並列關鍵字

health insurance ； length of stay ； health services utilization ； inpatients ； bed occupancy