醫院獨立總額對醫師診療行為之影響：以國軍醫院為例

The Impact of Individual Hospital Budgeting on Physicians' Practice Behavior in Military Hospitals

洪世明(Shih-Ming Hung) ； 錢慶文(Ching-Wen Chien)

《醫務管理期刊》 11卷4期 (2010/12) Pp. 265-279

https://doi.org/10.6174/JHM2010.11(4).265

摘要

Objective: To explore whether individual hospital budgeting implemented by military hospitals had any influence on physicians' practice behavior.
Methods: The study used a Nonequivalent Control Group Design and analyzed the 2003 to 2004 Taiwan National Health Insurance Research Database. We used military hospital physicians as our study subjects: 75 physicians who were involved in individual hospital budgeting (case group) and 40 physicians who were not (control group). Independent variables included the number of outpatient and inpatient visits, the expenditure for outpatient and inpatient visits, the number of outpatient and inpatient examinations, the expenditure for outpatient and inpatient examinations, the number of prescriptions days of outpatient visits and length of inpatient stays. Control variables included physicians' age and department, hospital level, primary care rate of outpatient and the severity of illness for each inpatient. We utilized Chi-Square tests, two sample t-tests, paired t tests, difference-in-difference (DID) and the general linear mixed model (GLMM) to conduct the analysis.
Results: The GLMM results showed that the case group had an increase in total inpatient visits (β=28.6, p＜0.05), total inpatient days (β=340.0, p＜0.05) and total expenditure for inpatient examinations (β=24.4, p＜0.05) after the implementation of individual hospital budgeting.
Conclusions: After individual hospital budgeting was implemented, the inpatient practice behavior of military physicians changed as they increased the medical utilization of inpatient departments.

關鍵字

醫院卓越計畫 ； 醫師行為 ； 總額支付制度 ； 論量計酬制度

並列摘要

Objective: To explore whether individual hospital budgeting implemented by military hospitals had any influence on physicians' practice behavior.
Methods: The study used a Nonequivalent Control Group Design and analyzed the 2003 to 2004 Taiwan National Health Insurance Research Database. We used military hospital physicians as our study subjects: 75 physicians who were involved in individual hospital budgeting (case group) and 40 physicians who were not (control group). Independent variables included the number of outpatient and inpatient visits, the expenditure for outpatient and inpatient visits, the number of outpatient and inpatient examinations, the expenditure for outpatient and inpatient examinations, the number of prescriptions days of outpatient visits and length of inpatient stays. Control variables included physicians' age and department, hospital level, primary care rate of outpatient and the severity of illness for each inpatient. We utilized Chi-Square tests, two sample t-tests, paired t tests, difference-in-difference (DID) and the general linear mixed model (GLMM) to conduct the analysis.
Results: The GLMM results showed that the case group had an increase in total inpatient visits (β=28.6, p＜0.05), total inpatient days (β=340.0, p＜0.05) and total expenditure for inpatient examinations (β=24.4, p＜0.05) after the implementation of individual hospital budgeting.
Conclusions: After individual hospital budgeting was implemented, the inpatient practice behavior of military physicians changed as they increased the medical utilization of inpatient departments.

並列關鍵字

Individual Hospital Budgeting ； physician behavior ； Global budget ； Fee-for-service

參考文獻

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Huttin, C.,Andra, J.(2000).How the reimbursement system may influence physicians' decisions results from focus groups interview in France.Health Policy.54(2),67-86.

黃麗鈴(2005)。由賽局理論看醫院卓越計畫實施後對醫院財務及品質之影響─以高屏轄區區域級以上醫院為例(碩士論文)。高雄醫學大學。