全民健保支付制度改變前後公立醫院與財團法人醫院服務量及醫療利益之比較

A Comparative Analysis of Medical Services and Financial Performances between Public and Non-profit Proprietary Hospitals before and after Introduction of the Case Payment System

陳明進(Ming-Chin Chen) ； 黃崇謙(Chung-Chien Huang)

《當代會計》 2卷2期 (2001/11) Pp. 169-193

https://doi.org/10.6675/JCA.2001.2.2.03

摘要

本文探討全民健保支付制度由論量計酬支付制改變為論病例計酬支付制對公立醫院與財團法人醫院服務量及醫療利益影響之比較，以民國86年10月1日開始實施論病例計酬支付制的八項病別進行實證分析。研究結果顯示，在健保支付方式改變為論病例計酬支付制下，醫院的平均住院日數普遍有明顯的減少，但病例的平均醫療費用則沒有顯著的減少；然而實施論病例計酬支付制後，醫院病例的服務量及收入總額卻明顯地增加，顯示論病例計酬支付制對於醫院增加服務量及收入的財務誘因有較大的影響。因此政府如果僅以支付制度作為抑制醫療資源浪費的做法，其成效可能有限。此外，本文的研究結果也顯示，實施論病計酬支付制後，財團法人醫院在控制醫療費用、增加服務量收入以及淨利率的績效表現均優於公立醫院，這些差異說明公立醫院與財團法人對於支付制度改變反應的效率並不相同，可供政府作為釐訂醫療管理政策之參考。

關鍵字

全民健保 ； 支付制度 ； 公立醫院 ； 財團法人醫院 ； 績效指標

並列摘要

In order to curb the rapid growth in medical expenditures, the administration of National Health Insurance (NHI) is gradually changing its payment system from the fee-for-service (FFS) payment system to the case payment one. This study explored the impacts of this policy on public and non-profit proprietary hospitals' medical services and financial performances, by comparing the before and after results of eight DRG codes incepted on October 1, 1997. The results show that, after the introduction of the case payment system, the average length of stay has decreased significantly, but no apparent evidence to conclude the average reimbursement has decreased. Nevertheless, both case volume and medical revenues have significantly increased after the inception of the case payment system. Further, we also found that nonprofit proprietary hospitals seem to outperform their public-sector counterparts in the selected financial indicators.

並列關鍵字

National Health Insurance ； Payment system ； Public hospital ； Nonprofit proprietary hospital ； Financial performance