實施台灣診斷關聯群組的比較分析初探－以一區域醫院爲例

The Preliminary Analysis of Tw-DRGs Implementation in a Regional Community Hospital

王瑞揚(Jui-Yang Wang) ； 陳聲平(Sheng-Pyng Chen) ； 佘振興(Zhen-Xing She) ； 曹宗聖(Tsung-Sheng Tsao) ； 林延光(Yen-Kuang Lin) ； 張義範(Yi-Fan Chang) ； 陳俊芳(Chun-Fang Chen) ； 康琪育(Chi-Yu Kang)

《中華職業醫學雜誌》 18卷3期 (2011/07) Pp. 221-226

https://doi.org/10.30027/CJOM.201107.0007

摘要

研究目的：本研究欲了解台灣診斷關聯群組(Tw-DRGs)支付制度前半年在某區域醫院之績效分析、醫療效率與執行成效的指標概況。研究方法：回溯收集2009年同期論病例計酬(case payment)之146例與2010年實施Tw-DRGs前半年的案例204例之相關數據做內部損益分析。再利用目前健保局公佈的全國資料及同層級醫院數據（「醫療效率」與「成效測量」面向指標），使用SPSS12.0中文版統計軟體作初步的描述與統計分析。研究結果：內部分析來看，業務績效高者投資報酬率不一定高，而某些特定科別其投資報酬率可達30%。實施Tw-DRGs前半年與去年case payment同期的比較，申報點數上升32.8%，實際醫療費用上升31.1%，投資報酬率上升1.5%，但績效統計上並無明顯差異。在前半年實施Tw-DRGs後的「醫療效率」比較，本院的平均住院日較全國與北區同層級醫院平均值為高，但實際醫療點數與（DRGs申報點數／實際醫療點數）的比值均較全國平均值與北區同層級醫院值為低。在本院執行「成效測量」方面，三日內再急診率與病例組合指標(case mix index, CMI)均低於全國與北區同層級醫院平均值，但兩週內再入院率高於全國與北區同層級醫院平均值。結論與建議：未來需要有更周全的提醒審核與討論改善機制，如控制住院天數、建立臨床路徑與健全長照體系等，以有效提升醫療效率與獲利率，並為未來更多即將納入Tw-DRGs支付制度的他科案例作準備。

關鍵字

台灣診斷關聯群組 ； 論病例計酬 ； 支付制度

並列摘要

Purposes: This research is about to comprehend the target survey of the payment system of Taiwan Diagnosis Related Groups (Tw-DRGs) in the achievements analysis, the medical efficiency and the implementation effect in some regional hospital in the first half of the year.Methods: To collect the related data of 146 cases of the case payment in the same term in 2009 and 204 cases of Tw-DRGs implemented in the first half of the year in 2010 to make the internal profit and loss analysis. Furthermore, to make the primary description and statistical analysis with the use of national material and data (the face target of the ”medical efficiency” and the ”result survey”) of the same leveled hospitals currently announced by Bureau of National Health Insurance and with the use of statistics software of Chinese version of SPSS12.0Results: From the internal analysis, it is not necessary to get high investment return rate for the ones who made high service achievements, and nevertheless, the investment return rate can reach to 30% for some specific departments. Compared with Tw-DRGs implemented in the first half of the year and the case payment in the same turn last year, the reported points rose 32.8%, the actual medical expense rose 31.1%, and the investment return rate rose 1.5%, but there was no obvious difference in achievements statistics. In the comparison of the medical efficiency after Tw-DRGs implemented in the first half of the year, the average of in-hospital days of this hospital is higher than the average value of the nation and that of the same leveled hospitals in the northern administrative division, but the actual medical points and the specific value (reported points of Tw-DRGs/actual medical points) of this hospital are lower than those of the nation and those of the same leveled hospitals in the northern administrative division. In the aspect of result survey executed in this hospital, the 3-days re-emergency rate and the case mix index (CMI) of this hospital are lower than those of the nation and those of the same leveled hospitals in the northern administrative division, but the 14-days rehospitalization rate of this hospital is higher than that of the nation and that of the same leveled hospitals.Conclusions: In the future, more complete reminder verification and discussion- on-improvement mechanism are needed, just like the control of in-hospital days, the foundation of clinical pathway, and the soundness of long-term care system which are all to improve medical efficiency and profit rate and to get the preparation for more cases of other departments going to be fit into Tw-DRGs payment system.

並列關鍵字

Taiwan diagnosis related groups Tw-DRGs ； case payment ； payment system