- 學位論文
TW-DRGs與影響醫療費用原因之探討—以中部某區域醫院DRG124為例
A Study of the Influence of the TW-DRGs on Medical Care Expenses－Based One DRG124 on a Regional Hospital
摘要
中央健保局為提昇醫療效率和品質，已於2010年1月1日開始實施診斷關聯群(Tw-DRGs)支付制度，因新制度的改變實施前後皆是各家醫院關注的焦點，本研究針對探討實施Tw-DRGs前醫院施行心導管病患，於病患來源及就醫歷史診斷中，對醫療費用的差異及原因探討，期能趨近於合理及有效的控制醫療費用，作為未來其他個案或醫院調整診療行為之參考。 研究方法，以中部某區域醫院為研究對象，採次級資料研究方法，擷取2007年1月至2009年12月間歸屬MDC5的DRG124循環性疾病，急性心肌梗塞除外，有心導管，有複雜診斷的住院病患，得樣本數共176筆，以第3.2版支付點數為基準，依病患來源由門、急診轉入住院，實際醫療點數及就醫歷史診斷記錄的差異，以驗證本研究之假說。 研究結果驗證，DRG124病患經描述性統計和t檢定分析後發現，在住院天數、處置費、藥費及醫療費用等，病患來源為門、急診轉住院者有差異，再以急診轉住院82位病患中，就醫歷史記錄區分有、無循環性疾病後發現，施行心導管的病患部份就醫歷史記錄中，也有消化性潰瘍的診斷。本研究建議因DRG124病患具有複雜診斷，可於歷次門診中觀察病情變化，依健保規定適時安排心導管檢查，儘量落入DRG125無複雜性診斷心導管檢查。具消化性潰瘍診斷病患看診時，建議關注病患是否有心血管疾病危險因子，需要時轉心臟內科治療，達到預防保健節省醫療費用的目的。
並列摘要
National Health Insurance Bureau (NHI) implements Diagnostic Related Groups (Tw-DRGs) payment system to enhance the quality of medical care since January 1, 2010. Due to impacts of the change, this study studies cardiac catheterization patients prior to the implementation, to discuss differences and causes with medical histories, sources, and medical expenses of patients. Our result can help a hospital manager to control expenses reasonable and effectively, and to be a reference to other cases or hospitals to adjust treatment procedures. Research methods：We study a regional hospital in central Taiwan; use secondary data methods; retrieve 176 patients from 2007 to 2009 vested the MDC5 DRG124 circulatory disease expect acute mi, with cardiac catheterization and complex diagnosis. Patients’ sources from outpatient or emergency, actual medical expense based on version 3.2 payment rule, and differences in medical histories are analyzed to verify hypothesis of this study. The results show that there are differences in the number of days in the hospital, inspection fees, pharmacy charge and medical expense by descriptive statistics and T test between DRG124 patients grouped by their sources. Then we analyze 82 patients from emergency, find that some patients who have peptic ulcer diagnosis in their medical histories. This study suggests that DRG124 patients can be observed in the previous; and be applied cardiac catheterization on the timing of the rules of NHI, as far as possible be sorted into DRG125 without complex diagnosis. When patients with peptic ulcer seeing the doctor, the doctor should propose a focus on patients for cardiovascular risk factors, transfers them to the Cardiology when necessary, in order to save medical expense of preventive health care purposes.