醫院總額後民眾在西醫基層與醫院醫療利用比較之研究

To compare the differences of healthcare utilization of patients using the primary care and hospitals after implemented hospital global budget payment system

黃清郁(huang ch'ing yü)

指導教授 ： 葉玲玲

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

西醫總額預算分為西醫基層與醫院兩總額，並分別設定醫療服務品質指標，即同一病患所獲得的西醫醫療照護，是以西醫基層與醫院兩總額相同品質指標但依不同監測值作評估，因此病人所接受的醫療照護服務之完整性值得進一步探討。研究目的為比較醫院總額前有就醫者，在醫院總額實施後至西醫基層與醫院的醫療利用情形，以探討西醫總額分為基層與醫院兩總額，對病人獲得醫療照護服務之影響。以全民健保資料庫1999 年至2005 年資料進行分析。研究對象為醫院總額實施後半年內有就醫者，利用該群病患醫院總額前的就醫申報資料，將其分類為固定醫院就醫者、固定基層就醫者與無固定層級就醫者三群，共138,779 人。
結果發現，醫院總額前為固定醫院就醫與無固定層級就醫者，在醫院總額後至基層就醫的人數分別增加了5.6%、5.9%。而醫院總額後研究對象有就醫者，平均每人的醫院門、住診醫療服務點數（門診約增加兩千點、住診約增加三萬點）及門診給藥天數（增加12~25 日）皆呈現增加。意即醫院總額後，研究對象的就醫層級有所改變。而西醫基層與醫院兩總額專業醫療服務品質指標有同有異，監測值亦不同，對於在西醫基層與醫院皆有就醫的病患，可能較無法確保其獲得之醫療照護品質。

關鍵字

基層診所、醫院、總額支付制度

並列摘要

The global budget payment system of health care services in Taiwan is divided into two parts, primary care and hospital, of each with separate medical service quality indicator; that is, the Western medical care obtained by one patient will be evaluated by the same quality indicator of different global budget sectors. Therefore, it is important to further explore the compressive healthcare service received by holistic patient.
For examining the effect of dividing into primary care and hospital global budget sectors by one holistic patient, this study is to compare the healthcare utilization of patients who received health care services after hospital global budget. From National Health Insurance claim database, we collected the information of patients who received health care services during 1999~2005 and proceeded with the data analysis. The research subjects are those who get medical attention within half year of the hospital global budget payment system; we use their previous medical registration information to classify the 138,779 subjects into three groups as follows: regular hospital patients, regular clinic patients and non-regular patients.
Research results show people who are regular hospital patients and non-regular patients before hospital global budget practice switch to local clinic for medical treatment at the increase of 5.6% and 5.9% respectively after the implement of hospital global budget. For those research subjects who seek medical services after hospital global budget payment system, there is an increase of the average hospital outpatient and administration patient health care service points (approximately, an increase of two thousand points in outpatient department and thirty thousand points in inpatient department) and also the duration of outpatient prescription (an increase of 12~25 days). In another words, after hospital global budget payment system, there is a habitual change of seeking health care services for research subjects. The primary care and hospital global budget payment system, with different monitor value, sometimes share the same professional health care services quality indicators; it is possible that the holistic health care quality cannot be assured for the patients who seek in both primary care and hospital health care services.

並列關鍵字

primry care；hospital；global budget payment system

參考文獻

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