醫院總額支付制度實施前後對固定醫院就醫病患醫療利用比較之研究

Changes in Medical Utilization of Patients in Hospital Sector after Implementation of Hospital Global Budget Payment System

陳素珊(Su-Shan Chen) ； 葉玲玲(Ling-Ling Yeh) ； 黃光華(Kuang-Hua Huang) ； 鄭文輝(Wen-Hui Cheng)

《醫務管理期刊》 9卷1期 (2008/03) Pp. 53-65

https://doi.org/10.6174/JHM2008.9(1).53

摘要

目的：本研究主要探討只在醫院就醫病患在醫院總額實施前後之醫療利用的變化，期待研究結果可作爲總額支付制度醫療資源分配之參考。
方法：研究對象爲醫院總額實施前二年只在醫院就醫病患，共4,043位。門住診醫療利用資料收集期間爲2000年7月至2004年6月，以每半年爲一期進行醫療利用分析比較，共分八期。
結果：醫院總額實施後病患各項住診醫療利用每半年成長幅度較實施前增加5.6%18.2%，醫院部門門診次數成長幅度減少1.0%，門診醫療服務點數增加0.4%。病患在醫院部門每半年的門診次數雖較實施前減少0.050~0.69次，但如果包括基層診所門診就醫次數，則每位病患之平均總門診次數則增加0.05~1.09次。
結論：病患在醫院部門門診就醫次數減少，但總門診就醫次數並未減少。門診醫療利用似乎從醫院部門移至基層診所，需進一步探討轉至基層診所就醫之病患並不是嚴重病患。政府也值得再審現劃分醫院與基層爲兩個總額的議題。

關鍵字

醫院總額支付制度 ； 醫療利用

並列摘要

Objectives: This study aims to investigate the changes in medical utilization of those patients who sought medical care services only in hospital sector after the implementation of Hospital Global Budget Payment System; thus, the implications for improving healthcare resources allocation can be derived.
Methods: The study includes 4043 subjects who sought medical care only in hospital sector during the period of two years prior to the implementation of Hospital Global Budget Payment System in July 2002. The data of their utilizing ambulatory and inpatient services in the period of July 2000 to June 2004 which are divided into eight sub-periods of half a year are analyzed.
Results: Two major findings are as following: (1) The utilization of inpatient services in per half a year sub-periods after the implementation of Hospital Global Budget Payment System has increased by 5.6-18.2%, while the number of ambulatory visits and the claimed points of outpatient services in hospital sector decreased by 1.0 and 0.4%, respectively. (2) Though the number of ambulatory visits in hospital sector has decreased by 0.05-0.69 visits, the total visits including both clinics and hospitals still increased by 0.05-1.09 visits.
Conclusions: Though ambulatory utilization of the patients has decreased in hospital sector after the implementation of Hospital Global Budget Payment System, the total outpatient visits including clinics and hospitals still increased. It seems to show that the patients shifted from hospitals to clinics. However, it needs further investigation to see if the transferred patients were in less severe conditions. Moreover, the relevance of separating the hospital and clinic global budgets deserves review.

並列關鍵字

Hospital Global Budget Payment System ； medical utilization

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