總額支付制度實施後區域以上醫院對高科技醫療設備設置情形之研究以多切面電腦斷層掃描儀(MDCT)為例

A Study of The Adoption and Utilization of High-Tech Technologies at The Hospital Level under The Global Budget System in Taiwan: The Case of Multi Detectors Computed Tomography (MDCT)

陳信泰(ch'ên hsin t'ai)

指導教授 ： 朱僑麗

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

背景：高科技醫療是造成醫療費用上漲主因之一。健保局自2001 年起實施總額預算支付制度，雖已適當控制健保醫療費用的成長，但醫院對高科技醫療之採行、擴散情形以及高科技醫療利用是否因總額預算實施而有所改變，仍有待探討。目標：以多偵測器電腦斷層掃描儀(Multi Detector Computed Tomography: MDCT)為例，探討總額預算實施後，台灣區區域以上醫院購置MDCT 原因及擴散情形，以及醫療利用是否有所改變。方法：(一) 以檔案分析方式及研究者蒐集整理，以瞭解總額預算實施後MDCT在台灣擴散之情形。(二) 以郵寄問卷調查之方式，訪問醫院放射部門主管、醫工部門主管，以瞭解醫院採購MDCT 的主要因素，以及使用MDCT於健保及自費醫療之利用人次。(三) 最後以行政院衛生署2000 年至2005年『醫療院所現況暨服務量調查』資料檔分析醫療院所購置CT 台數及其醫療服務量改變之趨勢。結果：醫院權屬別為私立醫院、醫師數越多、病床數越多者，越有可能購買MDCT；區域以上醫院採購MDCT 之原因，依回覆問卷填答百分比由高至低前五項分別為：『提高醫療品質』、『臨床需求』、『增進檢查效率』、『發展自費市場』、『提高醫院名聲』等。醫院購置MDCT 前後，CT 醫療利用人次變化無顯著差異。
結論：總額預算實施對私立醫院採用高科技醫療設備無顯著影響，裝置MDCT 後CT 醫療利用人次無明顯改變。

關鍵字

多切面電腦斷層掃描儀、高科技醫療設備、總額預算制度。

並列摘要

Objectives：New medical technologies have been identified as the leading cause of increasing healthcare expenditures. In Taiwan, the global budget payment system was carried out by the NHI since 2001.After that,the grouth of increasing healthcare expenditures was under control. However,whether the adoption behavior of new medical technologies in hospital setting is affected by the payment system is not well known in document.
With the case of multi detectors computed tomography(MDCT), it is to explore the diffusion of MDCT in Taiwan and to find out the decision factors in the adoption of MDCT since the global budget payment system was introduced in 2001,and to examine if the CT utilization rate was raised as well.Method：The number of installed MDCTs was obtained from the four medical instrument agencies in Taiwan.A questionare was designed to examine the decision factors in the acquisition of MDCT in hospital setting.Secondary data analysis was used to examine the changes in the CT utilization after the adoption of MDCT. Results：During Jan 2003 to Sep 2006，there were 60 MDCTs installed in Taiwan.The year growth rate was 41.4%.There were 52 questionares returned (n=92). To meet the clinical requirement,to improve the quality of care, to improve the workflow efficiency were the top three decision factors in the acquition of MDCT. Logistc
regression results show the number of physicians in the hospital,the hospital beds were both the factor affecting the adaption of MDCT. No obverserly changes in CT utilization after the adoption of MDCT.

並列關鍵字

Global budget system,hightech medical technologies,MDCT,CT

參考文獻

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