影響各醫院門、住診點值之因素探討

Factors Associated with Floating Values of Hospital Outpatient and Inpatient Services

張慧如(Huei-Ru Chang) ； 錢慶文(Ching-Wen Chien)

《醫務管理期刊》 7卷2期 (2006/06) Pp. 155-172

https://doi.org/10.6174/JHM2006.7(2).155

摘要

醫院總額預算的實施，對醫療院所收入造成相當嚴重的衝擊，而點值的不確定性，也牽動了醫院的管理方法。有鑑於此，因此本研究以2003年醫院總額點值為例，探討醫院之規模及營運特質與點值之間的關係，從營業面討論到底有哪些因素會影響各醫院的點值，並且討論造成點值差異背後的因素。
本研究資料來源共計有590家醫療院所，係採用健保局所公布之各醫療院所2003年之點值及營運相關資料。由於本研究變項之間相關甚高，故以逐步複迴歸分析為主要統計方法，來找出對門、住診點值具有顯著影響力的因素，事後檢定則利用變異數分析及Scheffe法。
本研究之研究結果顯示規模較大的醫院門、住診點值較高，規模較小的醫院門、住診點值卻較低，且不同健保分局所屬的醫院之門、住診點值是有差異的，所以除了醫院的結構特質外，市場因素也是影響點值的一個重要因素。因此建議衛生主管機關應重新檢討總額預算分配的模式，不該單由需求面來設定分配方式，也應考慮到市場因素以及醫療院所的結構面因素，如此才能更有效的促進醫療資源的分配公平；而在總額預算制度帶來巨大衝擊的環境下，各醫療院所也應該認真的去思考是否要改變以數量為主的醫療服務提供模式。

關鍵字

總額預算 ； 門住診點值

並列摘要

The implementation of hospital global budget has significant impact on hospital revenues. Additionally, uncertainty in point value influences hospital management. Based on these reasons, this study aims at exploring how point value of hospital services was influenced by hospital global budget, and discuss if point value has strong correlated to hospital structures and their operating characteristics. Factors which influence point values of hospitals were assessed from an operating perspective of hospitals and health care institutions.
This study included 590 hospitals and healthcare institutions. Financial data, in terms of point values of inpatient and outpatient services, and operation characteristics provided by the Bureau of National Health Insurance (BNHI) in 2003. Due to the strong correlations between studied variables, this study used multiple stepwise regression method to find out significant factors influencing average point values in outpatient and inpatient services. ANOVA and Scheffe tests were used to do post-hoc analysis.
Results of this study indicated that average point values of outpatient and inpatient services of large hospitals were higher than those of small one's. Besides, hospitals under different branches of BNHI yielded different average point values. Consequently, in addition to the structure of hospitals, market was the key variable affecting point value. In conclusion, this study suggests that health policy makers should reconsider the method in allocation of hospital global budget. In addition to demand perspective, market and hospital structures should also be taken into consideration to achieve effectiveness and reasonable distribution of medical recourses. Given the impact of hospital global budget, hospitals should be more concerned about changing their attitudes of quantity-oriented approaches to medical service provision.

並列關鍵字

Hospital Global Budget ； Point Value

參考文獻

邱永仁(1999)。總額預算制對醫界的影響。台灣醫界。42(9)，38-40。

全民健康保險醫療費用協定委員會()。

李玉春(1999)。全民健保支付制度現況檢討與改革方向建議。中華民國基層醫療協會年會。

莊念慈、黃國哲、許怡欣、郭乃文、魏中仁(2004)。醫院因應總額支付制度之策略方案及其相關因素探討。臺灣公共衛生雜誌。23(2)，150-158。

蔡正隆(2002)。總額支付制度對醫院醫師行為之影響(碩士論文)。國立政治大學。