醫院總額浮動點值對地區醫院財務衝擊之研究

Financial Impact of the Hospital Global Budget Floating Value System on Community Hospitals

鍾佩樺(Pei-Hwa Chung) ； 黃三桂(San-Quei Huang) ； 錢慶文(Chin-Gwen Chien)

《醫務管理期刊》 5卷2期 (2004/06) Pp. 208-221

摘要

財務安全一直是全民健保實施以來能否永續經營的一個隱憂。為控制日益高漲的全民健保醫療費用，衛生署於民國87年起開始逐步推動總額支付制度。西醫醫院醫院總額支付制度是從民國91年7月1日開始實施。由於西醫總額支付制度中對於醫療服務的給付除了健保政策上保障的急重症和藥品有關等費用外，均以浮動點值的方式來給付。這對傳統上急重症所佔的比重不高的地區醫院的財務就有很大的衝擊。所以本研究的主要目的即在探討浮動點值，對地區醫院收入面之影響。
本研究資料來源為民國九十一年七月至十二月，健保局某分局轄下之地區醫院申報之「門診（含住院）醫療服務點數清單」與「醫療機構」職業登錄等資料。先分別統計91年7月至9月（總額第一季）和10至12月（第二季）之門住診收入變化，再更進一步以標準化逐步複迴歸和t test來分析地區醫院之教學資格、醫院型態、所有權、病床數、執業醫師人數等變項對地區醫院收入之影響與差異。
本研究結果顯示，無論門診還是住院，在浮動點值實施後地區醫院的收入都收到相當高的損害。尤其是總額實施第二季時將急重症納入非浮動點值保障時，對於地區醫院收入負面的影響力倍增。本研究亦發現地區醫院的醫院型態和規模在浮動制度實施後對於門診收入變化率的影響最大。而地區醫院的所有權最可以解釋住院收入變化的主要原因。因此本研究建議健保局應該考慮對於中大型醫院進行一般門診量的限制，以免因浮動點值的缺乏配套措施加速地區醫院的財務危機，並危及好不容易才建立的醫療可近性。

關鍵字

總額預算制度 ； 浮動點值 ； 地區醫院

並列摘要

Financial safety has been the most important issue for the National Health Insurance (NHI) since its implementation on March 1995. For this purpose, the NHI has gradually adapted to global budget payment systems for all services included in the NHI. Hospital Global Budget(HGB) which is the last portion of the NHI' universal global budget system was implemented on July, 2002. At the beginning, the HGB guarantees to pay emergency care, severe acute services and other policy-awarded services at a fixed value and all other services at a floating value. This payment method has brought significant and negative impact on revenues of community hospitals because most community hospitals are small. Those services protected by the NHI did not account for a significant portion of their service volume. Therefore, in the long run, community hospitals are expected to face more financial distress than before. The objective of this study is to assess the influence of the floating value payment system on revenue changes of community hospitals. Besides, factors associated with change of revenues were also studied.
Inpatient and outpatient claim data and hospital characteristics data of 94 community hospitals from July to December 2002 were collected and analyzed. Those hospitals were located in six different counties/cities of northern Taiwan. Hospital characteristics included in this study were: teaching status, ownership, specialization, size and number of attending physicians of community hospitals.
Results of this study indicate that community hospitals will lose more revenue if more services are protected by the fixed value system. Besides, this study also finds that specialization and size of community hospitals were associated with percentage changes of outpatient revenues and ownership of community hospitals was associated with percentage changes of inpatient revenues were under the floating value payment in both HOB periods. Therefore, the author urge the Bureau of NHI should limit the volume of outpatient services of large hospitals so that community hospitals can survive and keep serving communities.

並列關鍵字

Hospital Global Budget ； Floating Value Payment System ； Community Hospital

參考文獻

王巧雲(1996)。我國地區醫院技術效率之研究－DEA方法之應用(碩士論文)。政治大學財政研究所。

王美芳(1994)。我國地區醫院功能之研究(碩士論文)。中國醫藥學院醫務管理研究所。

李玉春、蘇春蘭()。,未出版。

邱惠雀(1995)。地區醫院人力資源配置與營運績效之相關研究(碩士論文)。國立陽明大學醫務管理研究所。

洪思雯(2001)。市場定位與經營競爭度對地區醫院歇業影響之探討(碩士論文)。中國醫藥學院醫務管理研究所。