台灣Tw-DRGs制度下外科醫師資源影響腹腔膽囊切除醫術績效之研究

A Study of Surgeon Resourses Effect on the Medical Expenditures of Laparoscopic Cholecystectomy in Tw-DRGs Payment System

陳昱甫(Yu-Fu Chen) ； 董弘一(Hong-I Tong) ； 楊明元(Ming-Yuen Yang) ； 張德銘(Der-Ming Chang) ； 宋天洲(Tien-Chou Sung) ； 陳鴻曜(Hong-Yaw Chen) ； 柯成國(Chen-Guo Ker)

《南臺灣醫學雜誌》 11卷2期 (2015/12) Pp. 64-73

https://doi.org/10.6726/MJST.201512_11(2).0002

摘要

結果:主治醫師年平均手數量及主治醫師年資等因素進行醫療費用差異分析。年平均手術量＜ 49例之醫師之病人平均醫療費用43883.6元、50-99例之醫師平均醫療費用44637.1元、≧100例者之平均醫療費用39210.4元，結果差異顯著(P＜0.001)。主治醫師年資未滿5年之醫師治療的平均醫療費用44584.7元，滿五年以上者醫療費用41733.3元，達統計上的顯著差異(P=0.012)。醫師特質與手術利潤相關性分析主治醫師年平均手術量進行比較，有利潤組分佈比例在三組中較平均，而無利潤組則集中在手術量＜ 50例與50-99例兩組之中，各別佔約40%左右(P＜0.001)，有利潤組的病人接受年資滿5年以上的主治醫師施行手術的比例達到73.1% ，而無利潤組在同樣的狀況下則僅有64.2 %(P ＜0.001)。利潤影響因素邏輯斯迴歸分析發現外科醫師決定進行術前貴重儀器檢查及住院天數對于術利潤有顯著影響。

關鍵字

腹腔鏡 ； 膽囊切除術 ； 醫療績效 ； 手術量

並列摘要

Objective: This was a retrodrade study of surgical volum and seniority of surgeons affected on the medical expenditures of laparoscopic cholestectomy with the Tw-DRGs payment sytem. Methods: There were 1539 patients accepted laparoscopic cholesctectomy done by 8 surgeons during the period of 20032007 in our hospital. Data of these patients including basic profile and medical expenditures reported to Ministry of Taiwan Health Insurance with Tw-DRGs pament system were collected for analysis. Results: Medical expenditures were reported to be 4388.6, 44637.1, 39210.4 Taiwan dollar for the groups of annural operative volume ＜49, 50-99 and＞ 100 cases respectively (p=0.0001). If looking at surgeon seniority, 44584.7, and 41733 .3 73 Taiwan dollor for the surgeons ＜5 years and ＞5years seniority (p=0.012). Profits from these patients will be positive from the group of higher surgical volume and more the 5-year seniority surgeons. In addition, profits effected factors were included the useness of expensive pre-operative inmaging diagnositic CT or MRI, and length of stay. Conclusions: Total hospital profits were resulted from both surgeons who decided to use the pre-operative expensive diagnostic tool, and surgeon surgical volume and seniority under the payment sytem of Tw-DRGs.

並列關鍵字

laparoscopic cholecystectomy ； medical effectiveness ； surgical volume ； Tw-DRGs