高雄縣市婦產專科醫院四種常見醫療服務利用趨勢和影響因素

研究目的醫院經營管理的文獻對地區醫院經營呼吸照護，血液透析，骨科復健成為存活必要條件的探討分析非常多，唯獨對婦產專科醫院在地區醫院的經營和服務利用，卻少有文獻探討。本論文以產科、婦科四種常見之醫療處置，來探討婦產專科醫院在醫療服務利用上的趨勢變化、醫療照護品質和醫療資源耗用情況。目的一和二為探討婦產專科醫院與非婦產專科醫院在自然產、剖腹產、子宮切除與卵巢切除四種產科、婦科醫療服務利用人數的消長與趨勢變化。目的三和四為探討自然產、剖腹產、子宮切除與卵巢切除四種常見醫療服務的併發症、七天再住院、住院天數、醫療費用和影響因子。研究方法本研究使用健保資料庫次級資料。採用回溯性研究設計，資料期間為1996到2007年。以高雄縣市自然產、剖腹產、子宮切除與卵巢切除四種常見醫療處置病人為分析對象。首先用趨勢分析法探討婦產專科醫院與非婦產專科醫院的醫療服務利用人數消長與趨勢變化。再過來採用邏輯式迴歸分析檢定七天再住院、併發症兩種醫療照護品質和影響因子。採用線性迴歸分析檢定住院天數、醫療費用兩種醫療資源耗用和影響因子。研究結果自然產、剖腹產之醫療服務利用率，在婦產專科醫院呈現顯著線性增加趨勢。非婦產專科醫院及基層診所則呈現顯著線性減少趨勢。子宮切除、卵巢切除之醫療服務利用率，在婦產專科醫院呈現顯著之線性增加趨勢。醫學中心與一般地區醫院呈現線性減少，區域醫院呈現顯著之線性增加趨勢。醫療照護品質方面，婦產專科醫院在自然生產的倂發症發生率比非專科醫院高1.95倍，但剖腹產、子宮切除與卵巢切除的倂發症發生率都是專科醫院比較低。自然產、剖腹產、子宮切除與卵巢切除的7天再住院率皆無顯著的差別。醫療資源耗用方面，自然產、剖腹產、子宮切除的住院天數、醫療費用都是專科醫院比非婦產專科醫院低。卵巢切除的住院天數、醫療費用則無顯著的差別。結論和建議婦產專科醫院在產科及婦科四種常見醫療處置之務利用人數呈現大幅度的增加趨勢，向下對基層診所，向上對醫學中心、區域醫院及一般地區醫院等非婦產專科醫院的服務人數呈現顯著的擠壓現象。醫療照護品質佳，醫療資源耗用少。其他非婦產專科醫院的壓力不但面臨市佔率因專科醫院崛起而下降，同時要承受少子化引起總服務人次減少的壓力，這兩種壓力對非婦產專科醫院的婦產科經營是不容忽視的危機。本論文的結果顯示，婦產專科醫院把資源與人力聚焦在少量服務項目的策略，有非常突出的經營優勢及成本效益。成功的經營模式，足堪其他醫院及科別做為學習標竿。

關鍵字

自然產；剖腹產；子宮切除；卵巢切除；婦產科專科醫院；醫療服務利用

並列摘要

Research Purpose Extensive researches on respiratory care, dialysis and orthopedics rehabilitation as a necessary survival factor for the management of regional hospitals have been discussed. However, to date, few researches conducted on usages of operations and services in OBS/GYN Specialty hospital have been done. To explore the trend changes of health care and usages of the service quality in OBS/GYN Specialty hospital, this thesis will use clinical data to discuss the utilization trends, quality of medical care, and related medical resource utilization in four common OBS/GYN procedures.Objective one and two are to compare the trend of the NSD、CS 、hysterectomy and oophorectomy in OBS/GYN Specialty hospital and general hospitals.Objective three and four are to examine the risk factors of complications、7-days readmission rates 、LOS and medical expenditure from four common OBS/GYN procedures. Research Methods This study uses secondary data from Health Insurance database and performs the retrospective statistical analysis by using the obstetrics and gynecology department data files from the year of 1996 to the year of 2007. Research samples from four common OBS/GYN procedures including the NSD, CS, hysterectomy and oophorectomy of Kaohsiung County and Kaohsiung City were used in this study. To compare the trends of the four common procedures in OBS/GYN Specialty hospital and general hospitals, use the number fluctuation and change in trend. The medical care quality and impact factors in 7-day readmission and complications concurrency were analyzed by using logistic regression analysis. Linear regression analysis was used in the LOS and medical expenditure, the two medical resource consumption factors. Research Results The utilization of medical service in NSD and CS showed a significant increase in the OBS/GYN Specialty hospital but a decrease in Primary clinics and non-specialty hospital.The utilization of medical services in hysterectomy and oophorectomy is dramatically increased in the OBS/GYN Specialty hospital. This srevices generally showed a decrease trend in the medical centers and district hospitals but significantly increased in the regional hospital.For the quality of medical care, the incidence of complications in NSD is 1.95 times higer in the OBS/GYN Specialty hospital compared with the non-specialty hospital. However, the complication rate in CS, hysterectomy and oophorectomy are relatively low in OBS/GYN Specialty hospital. There is no significantly difference when compare 7-days readmission rates after NSD, CS, hysterectomy and oophorectomy in these hospitals.For the medical resources utilization, the LOS of hospitalization and hospital medical expenditure in NSD, CS and hysterectomy are lower in OBS/GYN Specialty hospital. There is no significant difference when analyzed the oophorectomy cases in these hospitals. Conclusions and recommendations The utilization of OBS/GYN Specialty hospitals in four common procedures showed a significant increase and has the negative correlations with these four services in the local clinics, medical centers, regional hospitals and district general hospitals. The OBS/GYN Specialty hospital is also show better medical care quality and consumes less medical resources. Other non-specialty hospital is facing the pressure of market share not only due to the rise of specialty hospital, but also to the reduced number of attendances reflected by the lower birth rate. These two pressures have caused the crisis on the operation of obstetrics and gynecology department in general hospitals. This thesis showed that OBS/GYN Specialty hospital focus their objectives only on a small number of specific services and are able to concentrate the resources and man power. This strategy shows a very prominent business advantages and cost-effectiveness and can serve as the benchmarking for the other hospitals and divisions.