DRGs對醫院醫療服務影響:以髖關節手術為例

THE IMPACTS OF THE DRGs ON HOSPITAL MEDICAL CARE SERVICES: THE CASE OF TOTAL HIP REPLACEMENT

陳冠文(CHEN, KUAN-WEN)

指導教授 ： 陳欽賢

國立臺北大學/社會科學學院/經濟學系/碩士(2012年)

摘要

由於人口老化和醫學進步，使得近年醫療費用持續上升，每年全民健康保險的支出逐年提高，由
2002 年的3300 多億元提升到民國2010 年的5000 億元。為降低財務壓力，全民健康保險在2010 年實
施DRGs 支付制度，本研究目的即在瞭解DRGs 支付制度實施之後，對於醫院醫療行為的影響。由理
論模型中可以得知，相較於論量計酬制度，DRGs 支付制度有誘因會促使醫院減少病人住院天數。實
証方面，本研究使用全民健康保險研究資料庫2009 及2010 年住院醫療費用清單明細檔，並挑選髖關
節手術作為研究對象，採用最小平方法和差異中的差異法來分析DRGs 支付制度實施之後，醫院住院
天數和醫療費用的變化。研究結果發現，整體樣本在實施DRGs 支付制度之後，住院天數和醫療費用
都有顯著下降，顯示醫院的確如理論預測有誘因去降低住院天數，來增加醫院利潤。在不同醫院層級
方面，區域醫院在實施DRGs 支付制度之後，平均住院天數雖然和醫學中心一樣都下降，但是區域醫
院下降幅度小於醫學中心，而且區域醫院平均醫療費用反而上升，表示不同層級醫院行為並不相同。

關鍵字

診斷關聯群支付制度

並列摘要

Because of population aging and medical technology progressing, health care xpenditures continue to rise in recent years. The annual national health insurance
expenditure increased from 330 billion NT dollars in 2002 to 500 billion NT dollars in 2010. In order to alleviate the financial pressure, the National Health Insurance
system implemented Diagnosis Related Groups (DRGs) payment system in 2010. The purpose of this study was to analyze the impacts of the DRGs system on hospital medical care services. Data were drawn from the 2009 and 2010 National Health Insurance Research Database. Inpatient records for total hip replacement patients were used in the study. The ordinary least squares regression model and the difference
in difference method were adopted to analyze the changes in days of hospitalization and medical expenses. The empirical results showed that the average number of inpatient days and medical expenses for total hip replacement patients had dropped significantly overall after the implementation of DRGs system. It indicated that the DRGs system would encourage hospitals to reduce numbers of inpatient days to
increase profits. However, the impacts on hospitals were different for different level of hospitals.

並列關鍵字

DRGs

參考文獻

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