健保實施DRGs對醫學中心之影響：CTT與IRT之比較

Influence and Impact on Medical Centers under DRGs: CTT vs IRT

錢才瑋(Tsair-Wei Chien) ； 王文中(Wen-Chung Wang)

《致遠管理學院學報》 2_2期 (2007/09) Pp. 89-106

https://doi.org/10.6595/BDCM.2007.2(2).5

摘要

This study examined the impact of medical centers in Taiwan under DRGs. The aims were set at (1) knowing the influence in the first and following 4 years, (2) exploring the statistically significant different starting time under DRGs, (3) evaluating the revenue declining and rebounding cut-off point in the period of DRGs implementation time.
The DRGs costs of all the 17 medical centers were calculated for the year 2004 on 185 DRGs resulting from those 6 major diagnostic categories of No. 3, 9, 11, 13, 23 and 24. Rasch analysis　with Winstpes software was used examining a total of 94,536 discharges of DRGs to compare the revenue changes through those two ways of classic test theory and item response theory.
The results shows that government-run hospitals will be influenced much more than the private ones. Only non-profit run hospitals were shown no statistically significant difference in revenue decline across future 4 year under DRGs. Southern and Central medical centers in Taiwan were said to be improved in revenue at the fourth upcoming year. There are a few differences resulting from the methods of IRT and CTT, which might be attributed to the unfitted April data removed from this study through Rasch analysis of IRT.

關鍵字

診斷關係群 ； Rasch分析 ； 古典測驗理論 ； 試題反應理論 ； Winsteps

並列摘要

This study examined the impact of medical centers in Taiwan under DRGs. The aims were set at (1) knowing the influence in the first and following 4 years, (2) exploring the statistically significant different starting time under DRGs, (3) evaluating the revenue declining and rebounding cut-off point in the period of DRGs implementation time.
The DRGs costs of all the 17 medical centers were calculated for the year 2004 on 185 DRGs resulting from those 6 major diagnostic categories of No. 3, 9, 11, 13, 23 and 24. Rasch analysis　with Winstpes software was used examining a total of 94,536 discharges of DRGs to compare the revenue changes through those two ways of classic test theory and item response theory.
The results shows that government-run hospitals will be influenced much more than the private ones. Only non-profit run hospitals were shown no statistically significant difference in revenue decline across future 4 year under DRGs. Southern and Central medical centers in Taiwan were said to be improved in revenue at the fourth upcoming year. There are a few differences resulting from the methods of IRT and CTT, which might be attributed to the unfitted April data removed from this study through Rasch analysis of IRT.

並列關鍵字

DRGs ； Rasch analysis ； CCT ； IRT ； Winsteps

參考文獻

王文中(1997)。測驗的建構：因素分析還是Rasch分析？。調查研究。3，129-166。

王文中、呂金變、吳毓瑩、張郁雯、張淑慧(1999)。教育測驗與評量－教室學習觀點。台北:五南。

王文中(2004)。Rasch測量理論與其在教育和心理之應用。教育與心理研究。27，637-694。

王文中()。

陳琇玲、楊銘欽、薛亞聖、楊捷如(2005)。健保局DRGs對台灣病例變異解釋力之初探。台灣公共衛生雜誌。24(6)，548-560。