研究目的:健保局為能減緩持續上漲的醫療費用支出,規劃實施台灣版診斷關聯群(Tw-DRGs)。醫界擔心醫院會因此受到財務衝擊,造成經營困境。本研究將分析Tw-DRGs支付制度,對整體醫院及各層級醫院的財務衝擊。 研究設計:橫斷性模擬分析。利用次級資料庫,以模擬方式計算Tw-DRGs實施後醫院的財務衝擊。以模擬Tw-DRGs的醫療費用減去論量計酬的醫療費用後所得的收益差,評估醫院的財務衝擊。並利用t檢定,檢定實施Tw-DRGs後的收益差。 資料來源:採國家衛生研究院2007年全民健康保險學術研究資料庫,系統抽樣 檔之「住院基本資料檔(DD)」及「醫事機構基本資料檔(HOSB)」。 研究對象:DRG病例 研究工具:中央健康保險局2004年第三版「住院病例組合單機版編審程式 V7.3.4」與中央健康保險局2004年第三版DRG碼權重表。 結果測量:醫院收益差 主要結果: 一、Tw-DRGs實施後,整體醫院收益差為正值,t = 4.17,p<0.01。 二、Tw-DRGs實施後,地區醫院收益差為正值,t = 29.19,p<0.01。 三、Tw-DRGs實施後,區域醫院收益差為正值,t = 9.6,p<0.01。 四、Tw-DRGs實施後,醫學中心收益差為負值,t = -19.93,p<0.01。 結論: Tw-DRGs實施後整體醫院醫療費用收益差是正值。Tw-DRGs制度實施,在不同層級間有不同的財務衝擊,其個別財務衝擊為:醫學中心收益差為負值;區域醫院收益差為正值;地區醫院收益差為正值。
Abstract Research Purpose:For containing the medical expenditure, the Bureau of National Health Insurance (BNHI) implemented Taiwan Diagnosis Related Groups (Tw-DRGs). through 5 steps since 2010.Hospitals concern the financial impacts of Tw-DRGs. This study analyzed the financial impacts of Tw-DRGs payment system for all hospitals and different level. Research Design: This study simulats the Tw-DRGs and observes the financing impacts compared with the Fee for service by 2007 BNHI databank. The financial impact of Tw-DRGs is tested by t-test. Data Resource: Secondary data analysis was conducted on inpatient expenditures by admissions (DD) and registry for contracted medical facilities (HOSB) sourced from the 2007 National Health Insurance Research Database of the National Health Research Institutes. Research Subject: DRG cases. Research Tool: The tools included the 3rd case mix index coding program V7.3.4 of BNHI 2004 and the third version of the weight of DRG codes released of BNHI 2004. Outcome Measure: Difference in revenue Main Results: 1. For among all hospitals the difference in revenue is positive, t = 4.17, p<0.01. 2. For among district hospitals the difference in revenue is positive , t = 29.19, p<0.01. 3. For among regional hospitals the difference in revenue is positive, t = 9.6,p<0.01. 4. For among medical centers the difference in revenue is negative,t = -19.93,p<0.01. Conclusion: After implementing Tw-DRGs, the difference in revenue is positive among all hospitals in general. And for hospital levels, medical centers are negative, regional hospitals are positive, district hospitals are positive. Keywords: Taiwan Diagnosis Related Groups (Tw-DRGs), financial impact, difference in revenue, Fee for service.