- 期刊
臺北市立醫院自主管理之初步評估
Preliminary Evaluation of the Effect of an Autonomous Payment Management System in Municipal Hospitals
摘要
本研究旨在台北市醫八家醫院實施自主管理方案後半年，作財務及品質管理指標面之成效評估。方法：利用健保局台北分局提供之92年第三、四季之健保申報資料，比較其醫療費用及品質指標之變化情形。結果：自主管理方案實施半年後，在醫療費用方面－因SARS影響申報點數均無超過基準值10%，費用大致比91年同期點數稍微下降，然台北市立醫院92年第四季申報點數與基值比較均比第三季大幅成長；門住診指標方面-八家醫院平均達成率約為55%，且經過醫院內部控管後，第四季指標達成率均比第三季呈現正成長；在回饋比率分析方面-八家醫院平均為47.6%，先保障點數且增加自主管理指標回饋金。結論：自主管理方案之有形效益為可預先避免龐大的核減金額，降低風險，增加指標回饋金及節省往年申覆與爭審調閱病歷人力、辦公材料費；無形效益則為回歸醫療專業自主權，可以讓醫師再創造更大的效益，正面的醫療品質提昇及形象塑造，及配合健保局政策推動論質計酬照護計畫，讓市立醫院團隊可以致力於提昇公共衛生品質、加強預防保健。
並列摘要
Purpose: This research evaluates the effects on finance and medical quality measured six months after the introduction of the hospital autonomy-management payment system in eight Taipei municipal hospitals. Methods: The medical expenditure claims of eight hospitals were collected from the Bureau of National Health Insurance (BNHI), Taipei branch, during the 3rd and 4th quarter of 2003. We collected and analyzed the changes in medical expenditure payments and medical quality indicator outcomes. Results: Six months after the introduction of the hospital autonomy-management payment system, we found the following: (1) none of the hospitals payments of medical expenditure claims exceeded 10% of the base volume and the payments by all hospitals was somewhat less than that in the same two quarters of the previous year (2002) even though 2003 had been impacted by the SARS crisis. However, the payment of claims was greater in the 4th quarter compared to the 3rd quarter of 2003. (2) reviewing the medical quality indicator outcomes, the average achievement rates for the eight hospitals was about 55%, and the rates were better in the 4th quarter than in the 3rd quarter. (3) even though payment of medical expenditure claims in the period of study was less than that in previous year, compensation was feed back to city hospitals for quality maintenance at the eight hospitals and this totaled NT$60 million (47.6% of the deducted payment by BNHI). Conclusions: The study confirms that the effect of the autonomy-management payment system was to reduce the money deducted from BNHI and this was compensated by money given to the hospitals based on their meeting of quality indicators. The manpower and administrative fees needed for the defense or appeal procedures, and related to the costs of the so-called ”misuse medical resources supervision” by the BNHI, were also be saved. In addition, the invisible effects were a resumption of the autonomy of medical professionals, an improvement in the quality of medical care, the implementation of the ”quality based care payment plan” introduced by BNHI, and an emphasis on the ability of municipal hospitals to provide good medical and health services for Taipei citizens.(Full Text Chinese)