腹腔鏡膽囊切除術在論病例計酬制之成本效益研究

A Study of Cost Effectiveness in the Case Payment of Laparoscopic Cholecystectomy

董弘一(Hong-Yi Tung) ； 陳昱甫(Yu-Fu Chen)

《南臺灣醫學雜誌》 9卷1期 (2013/06) Pp. 15-31

https://doi.org/10.6726/MJST.201306_9(1).0003

摘要

目的：研究在探討影響腹腔鏡膽囊切除術住院病人總體醫療費用之因素，同時分析在論病例計酬制下， 可能影響醫療機構經營利潤的因素。方法：採回溯性橫斷研究設計，以高雄某區域教學醫院2003年至2007年間1539位接受腹腔鏡膽囊切除術者為研究樣本， 採用病歷查閱方法並結合該研究醫院健保申報費用資料檔， 利用複迴歸與邏輯斯迴歸模式， 在控制各種相關因素之後進行影響病人醫療費用、醫院利潤之相關因素探討。結果：在1539位研究樣本中， 男性613人、女性926人， 平均年齡為54.5歲（標準差14.2歲）， 主要由門診收治住院，共計有1313人（85.3%）， 未有手術後死亡個案，平均住院天數為3.79天（標準差為3.13天），平均總醫療費用為42528.1元（標準差17410.0元）， 未超額申報有1366人（88.8%），超額可核實申報133人（8.6%），超額未核實申報有40人（2.6%）。經複迴歸分析後發現對總醫療費用呈現顯著相關的因素包括年度、年齡、入院來源、主症狀、Charlson共病指數（CCI）、術後合併症、住院天數。與醫院經營利潤勝算比達顯著之因素包括年度、入院來源、主症狀、術前貴重儀器檢查及住院天數。結論：論病例計酬支付制度可有效控制醫療資源耗用， 而住院天數對醫療費用與醫院經營利潤都是一個關鍵的影響因素， 建議醫院經營者可以透過適當的方法例如臨床路徑進行內部管理。

關鍵字

腹腔鏡膽囊切除術 ； 論病例計酬 ； DRG制度 ； 總醫療費用

並列摘要

Objective: This study wanted to explore the associated factors that will affect the total medical expense in the patients who receive laparoscopic cholecystectomy (LC). We also evaluated what kind of the influencing factors that will associate with hospital benefits under the case payment system.Methods: This is a retrospective cross-sectional study design. Total 1539 patient's data was collected from year 2003 to 2007, who received LC in a general teaching hospital in Kaohsiung city. We also adopt the chart review and combined with the health insurance expense data to explore the interesting factors that were associated with total hospitalized expenses, and hospital benefits. We used multiple linear regression and logistic regression methods in proof of our finding.Results: In all study samples, the male were 613 subjects and the female were 926 subjects. The average age was 54.4 yr, and 1313 subjects were hospitalized from outpatient. All subject's average hospitalized days were 3.79 and medical expenses were 42528.1 dollars. The frequencies of the type of declaration about 'not exceed', 'exceed but actually', and 'exceed but no actually' were 88.8%, 8.6%, and 2.6%, in sequence. The significant factors that were associated with total hospitalized expenses were the year, age, source of hospitalize, major symptom, Charlson Comorbidity Index, a complication after surgery, and length of stay. For the odds ratio of hospital benifits, the significant factors we found were year, source of hospitalize, major symptom, high technology examination before surgery, and length of stay.Conclusions: The case payment system can control a comsumption of medical expenses. In this study we think that major factor is length of stay that will be a stronger influences the total hospitalized expenses and hospital benifits. The superintendent can carry on the management through the appropriate method such as clinical pathway to control the medical resource consumes.

並列關鍵字

laparoscopic cholecystectomy ； LC ； case payment system ； DRG ； total hospitalized expenses