不同物理治療分級支付標準對各級醫療院所之影響

Impact of the Physical Therapy Reimbursement Policies on Various Levels of Medical Institutes

洪珍瑜(Jane-Yu Hong) ； 曹昭懿(Jau-Yih Tsauo) ； 吳英黛(Ying-Tai Wu)

《中華民國物理治療學會雜誌》 24卷2期 (1999/03) Pp. 63-69

https://doi.org/10.29616/JPTAROC.199903.0002

摘要

物理治療給付從公勞保時代開始，其支付制度，隨著保險機構的不同而有所變遷。支付制度的設計關係醫療資源的分佈，可能影響醫療人力的走向與醫療院所經營的規劃，利用支付制度及標準的設計來影響醫療供應者的服務，可能是管理醫療時代的趨勢之一。本研究目的為探討健保局87年前後之新舊支付標準，也就是舊三級制、新三級制、四級制以及單一支付和二級支付兩種草擬標準對各級醫療院所之影響，以及各種支付標準下健保支出之改變。本研究將曾向臺北市健保局專案中請物理治療醫療給付的特約醫療院所，在民國86年8、9、10月之申報資料中，取醫令42001A~42016C共16項，以五種不同的支付標準－舊三級制，新三級制（87年1月l日至87年4月30日），四級制（87年5月l日起）、一級制及二級制計算健保給付之總金額，並比較對各級醫療院所收益的衝擊。結果顯示新三級制及四級制只會影響復健科診所，其他各級醫療院所則不受影響。單一支付標準有利於原A級醫療院所以外的醫療單位。二級支付標準對A級醫療院所給付沒有改變，而有利於原C級醫療院所。五種支付標準中，以實施新三級制之健保總支出為最低。

關鍵字

全民健康保險 ； 支付標凖 ； 物理治療

並列摘要

Reimbursement policy for medical services affect the distribution of medical resources thus it potentially affect the medically related manpower and operation. Reimbursement policy is also a powerful tool for improving medical services, especially in the age of managed care. Reimbursement policies for physical therapy services in Taiwan have undergone a great deal of transformation as a result of changes in insurance underwriting agencies and their policies. The purpose of this research was to investigate the impact of five different physical therapy payment methods on various levels of medical institutes and on the expenditure of the National Health Insurance (NHI) Bureau since its inception. The five payment methods included three-level pricing method, proposed one-level method by NHI bureau, proposed two-level method by Physical Therapy Association, revised three-level, and four-level pricing method. Physical therapy reimbursement by Bureau of National Health Insurance for medical centers, hospitals, and clinics in Taipei during the period of August through October 1997 were reviewed. A total of 16 items from medical ordinance 42001A to 42016C were used for calculation. The result of this investigation indicated that the revised three-level pricing and the four-level pricing method made little changes to the majority of medical institutes, except the rehabilitation clinics which would have decreased payment. The proposed one-level pricing method benefited all but class A hospitals. The two-level pricing method benefited all but class C hospitals and clinics. The revised three-level pricing method were most efficient from the view point of lost containment. The possible impact on service quality and service availability by the different pricing methods were also discussed.

並列關鍵字

National health care insurance ； Reimbursement ； Physical therapy