應用模擬分析Tw-DRG支付系統設計對於醫院營運之影響：以某醫學中心為例

A Simulation Study on the Effect of Diagnosis Related Group Design in Length-of-Stay and Case-Mix Index for Hospitals in Taiwan：a Case Study

陳建強(Jian-chiang Chen)

指導教授 ： 蔡佩芳

國立臺北科技大學/管理學院/工業工程與管理系碩士班/碩士(2012年)

摘要

台灣政府近年來推行以診斷關聯群(Taiwan Diagnosis Related Groups；Tw-DRGs)為主要的健保付費制度，本研究目的是探討全面實施Tw-DRG支付通則對於醫院管理之影響性。根據某醫學中心提供的心臟內科之樣本資料，運用蒙地卡羅技術發展超模式(Meta-model)。藉由基準模型驗證通過，建構Tw-DRG模型。Tw-DRG模型探討不同程度的變異係數大小對於住院天數等指標之影響性。本研究並進一步針對病例組合指標，探討醫院服務患者的比例結構不同時，對於住院天數等指標之影響性。研究結果顯示全面實施Tw-DRG確實可以降低總住院天數約15%，另外變異係數程度在0.2至0.8之間對於住院天數並無顯著的差異。而病例組合指標與住院天數呈現負相關性，高風險族群的住院病患越高對於整體的住院天數呈現下降的趨勢。病例組合指標只能用於衡量各醫院的資源耗用量，並無法直接判斷住院天數的長短。整體而言，全面實施Tw-DRG確實能為醫院帶來效益，降低整體的住院天數，提高病床週轉率。

關鍵字

Tw-DRG ； 模擬分析 ； 住院天數

並列摘要

Decisions in hospital management are highly dependent on the inpatient reimbursement system of the country. Due to limited budgets, many countries changed problematic public inpatient reimbursement systems that influenced hospitals to extend the patients’ length of stay (day-based system) or to increase services for patients (fee-for-service-based system) in order to maximize their income to reimbursement systems that help contain costs. This research was motivated in finding good bed management strategies when dealing with the potential reforms in hospital financing system: from global budget systems to diagnosis related groups (Tw-DRG). The aims of this study were to develop an appropriate infrastructure in analyzing bed management system, and hence provide managerial information for both hospital managers and physicians on the impact of new payment system to bed turnover rate and length of stay.
In this study, a simulation meta-modeling approach was used to explore the potential impact in full-scale implementation of Taiwan’s diagnosis related groups (Tw-DRG) payment system on efficiency measures such as length of stay (LOS) and case-mix index (CMI). The aim of this research was to identify the levels of variation in the design of DRG on the expected response from healthcare providers. Results showed that the greatest reduction in total LOS was achieved when the coefficient of variance (CV), or unitized risk, was within 0.8. Furthermore, the mean LOS would be decreased further if the hospitals took more cases with high-risks. This simulation study provided expectation in adopting higher CMI for better financial calculation and higher bed turnover when switching to Tw-DRG payment system.

並列關鍵字

Tw-DRG ； Simulation technique ； Length of stay

參考文獻

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