模擬實施新制DRG(Tw-DRGs)對醫療費用之影響及因應之道－以股骨轉子間骨折(210, 211)爲例

The Influence of Taiwan-DRGs on Hospital Costs for the Repair of Intertrochanter Fracture of the Femur

李佳霖(Chia-Lin Lee) ； 方莉(Li Fang) ； 李聖瑤(Shang-Yao Lee) ； 蔡桂香(Kuei-Hsiang Tsai) ； 韋有升(Yeou-Sheng Wei)

《醫務管理期刊》 10卷3期 (2009/09) Pp. 153-164

https://doi.org/10.6174/JHM2009.10(3).153

摘要

目的：本文在探討推出台灣新制DRG(Taiwan-DRGs)〔以下簡稱新制DRG(Tw-DRGs)〕對醫療費用的影響，在控制使用的骨科耗材費用後，對同樣的疾病但是分屬不同新制DRG(Tw-DRGs)組別進行分析。
方法：在南部一家區域醫院中股骨轉子間骨折之52個案例，以病人年齡、有無併發症或合併症(Complications or Comorbidities)〔以下簡稱CC〕及簡單／複雜診斷以及出院轉歸區分各個組合來分爲Tw-DRGs 210及Tw-DRGs 211兩組來區分給付金額，分出屬於第一組有CC及複雜診斷之Group 1(Tw-DRGs 210)及第二組沒有CC及簡單診斷之Group 2(Tw-DRGs 211)兩組，以SPSS 13.0統計軟體進行統計檢定，以描述性統計分析來說明收案樣本之人口學資料及各種費用，再以配對t檢定及單因子變異數分析進行差異性之檢定。
結果：在實際金額(FFS)、特殊檢查費、住院日數中會因組別不同而有顯著差異。統計全部52例個案，實施新制DRG(Tw-DRGs)前後比較實際費用與DRG支付定額並無顯著差異，而在Group 2 Tw-DRG 211這組實施前後於金額平均數上有差異，DRG實施後於收入金額（健保局所支付定額）較實際費用多。
結論：研究結果顯示，針對股骨轉子間骨折接受手術之患者，實施新制DRG(Tw-DRGs)後，醫療費用無明顯之差異。屬於第二組Group 2 Tw-DRG 211病患，醫院平均會有一萬餘點數的盈餘。而屬於第一組有CC之Group 1(Tw-DRGs 210)，醫療費用可能會有超過健保局所支付的DRG定額。

關鍵字

股骨轉子間骨折femur intertrochanter fracture ； 新制診斷關係群Tw-DRGs

並列摘要

Objective: The purpose of this study was to observe the changes in hospital costs and reimbursements after the introduction of the new diagnosisrelated group (DRG) payment system in Taiwan (Tw-DRGs).
Methods: We recruited 52 patients who suffered from intertrochanter fracture of the femur from a regional teaching hospital in southern Taiwan. The patients were divided into two groups for analysis. Those who had more complex diagnoses and complications or comorbid conditions were classified as Group 1 (Tw-DRG 210), and the patients who had a simple diagnosis were classified as Group 2 (Tw-DRG 211). SPSS 13.0 software was used to analyze the data. Descriptive statistics were used to analyze the demographic data and costs. Paired t-tests and one way analysis of variance were used to analyze the differences between groups.
Results: Between the two groups, the FFS (Fee for service), the special examination (Computed Tomography and Panendoscopy) and the length of hospital stay were significantly different. The total hospital costs for these patients was not significantly different after the new payment system was introduced, but in Group 2 the hospital payment which the Taiwan's Bureau of National Health Insurance (BNHI) offered was higher than the actual cost and in Group 1 it was lower.
Conclusions: The results of this study indicate that the hospital payment from the BNHI was not significantly different from the actual medical costs for the total number of patients with intertrochanter fracture of the femur. The patients who belonged to Group 2 (Tw-DRG 211) usually had lower hospital costs than the payment received from BNHI, but the hospital costs for the patients in Group 1 (Tw-DRG 210) were usually higher than the payment received.

並列關鍵字

introchanter fracture of the femur ； Tw-DRGs ； payment

參考文獻

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