台灣診斷關聯群支付制度對腹股溝疝氣手術給付影響之探討

目的：探討台灣診斷關聯群(Tw- DRGs : Taiwan - Diagnosis Related groups)實施後對腹股溝疝氣手術住院日數及醫療費用之影響。方法：以回溯性資料探討某區域醫院泌尿科腹股溝疝氣手術1030個住院病人(實施前2004-2009年434人次，實施後2010-2015年596人次)，以t檢定及逐步迴歸分析實施前後的各項變項，並考慮該手術不同DRG碼。結果：Tw-DRGs的實施，住院日數顯著下降0.21天，耗用、申報及收益差分別顯著增加1910.36、3883.40及1973.03點，可解釋變異量為1.7、4.6、14.1與11.3%，而耗用費別之檢查費、藥費、及放射費則顯著減少。DRG碼在耗用及申報點數迴歸分析中有重要解釋力，DRG16201及DRG 16101相較於DRG 16202耗用點數(可解釋變異量為27.0%及10.0%)及申報點數(可解釋變異量為28.5%及15.6%)顯著較多。此外，t檢定中，DRG 16102及DRG 16101的收益差顯著增加3653.69及8946.82點，比DRG 16202顯著增加1581.04點較高，迴歸分析可解釋變異量為1.8%及1.4%。結論：腹股溝疝氣手術在Tw- DRGs實施後，住院日數減少且收益差增加，建議醫院加強正確編碼，並找出影響收益差之病人特性來控管費用，以因應未來Tw-DRGs擴大實施帶來的衝擊。

關鍵字

全民健康保險住院診斷關聯群；醫療費用；住院日數；收益差；腹股溝疝氣

並列摘要

Objective: To investigate the effects of Implementing Taiwan-Diagnosis Related Group (Tw-DRGs) on length of stay and medical expenses. Methods: We retrospectively collected 1030 patients with inguinal hernia from one regional hospital's claims data for six years prior to and six years after Tw-DRGs was implemented. Independent t-test and stepwise regression analysis was employed to identify the critical predictors. Results: After Tw-DRGs, LOS was significantly declined 0.21 day. The medical cost, medical claim and difference in revenue were significantly increased 1910.36, 3883.40 and 1973.03 points, respectively. The laboratory, pharmacy, and radiation fee were significantly reduced 330.82, 141.35 and 93.88 points, respectively. The points of difference in revenue on DRG16101 and DRG16102 (8946.82 and 3653.69 points) were significantly more increased than DRG16202 (1581.04 points). Conclusions : Tw-DRGs had a significant impact on the LOS and medical expenses. The hospital should strengthen ICD coding and control costs in response to the impact of Tw-DRGs.

並列關鍵字

Taiwan Diagnosis Related Groups (Tw-DRGs) ； medical expenses ； length of stay ； difference in revenue ； inguinal hernia

國際替代計量

台灣診斷關聯群支付制度對腹股溝疝氣手術給付影響之探討

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