醫院卓越計畫對門住診費用比例影響之研究：以中區分局為例

The Effect on Expenditure between Outpatient Services and Hospitalization for Center of Excellence：Examples of Bureau of National Insurance the Central Region Branch

陳素惠(Chen Su Hui)

指導教授 ： 藍守仁

亞洲大學/健康學院/健康管理研究所/碩士(2005年)

摘要

中 文 摘 要
醫院卓越計畫在醫院個別預算與醫院自主管理的概念之下，引導醫院以合作代替競爭，降低醫院改革風險，為導正國內醫院重門診輕住院之現象，並將門住診比例訂為必要指標。本研究旨在探討醫院卓越計畫對門住診費用比例及醫療服務量之影響。以民國93年7月1日醫院卓越計畫實施為區隔，使用93年中區分局2家醫學中心、6家區域醫院、41家地區醫院，共49家參加卓越計畫醫院之資料進行統計分析。
本研究之主要實證發現：
1、 各層級醫院在參與卓越計畫以後，顯示各醫院雖然以內部管控措施調配門住診費用比例，但其改變仍無法讓地區醫院之門診費用比例降至45%，甚至有22家地區醫院門診比例超過50%，此結果將造成地區醫院門住診雙重損失，影響醫院營運。
2、 各層級醫院之門診點數及件數均有下降情形，其中地區醫院門診點數及件數的改變達統計上顯著差異，雖然如此，但地區醫院仍無法達到門住診費用比例的目標值，顯示45﹪：55﹪門住診費用比例之規定，對地區醫院而言是一項不易達成的任務。
3、 醫學中心之醫院16減少的門診點數中藥費佔66%,其餘34%為其他門診項目，而醫院8之門診藥費雖然減少，但是其他項目之門診費用卻有增加的情形，顯示兩家醫院的內部管控措施有所差異。
4、 區域醫院減少的門診點數之中藥費佔61%，地區醫院減少的門診點數之中藥費佔69%，顯示卓越計畫能夠更適度的管控藥品，而以往引人詬病的藥品浮濫的情形因而有改善。
5、 各醫院參加卓越計畫之後，門診手術件數均有降低情形，但門診手術點數卻有增加情形，住診手術點數及件數均有增加情形，但並無明顯顯示各醫院將門診手術轉移至住院手術之情形，此情形值得我們進一步再探討。
門住診費用比例之規定，並不能完全控制門診比例過高之問題，建議應配合分級轉診制度、分級部分負擔制度、醫療資訊公開透明化及加強民眾衛教宣導，才能有效控制門診醫療費用。

關鍵字：醫院卓越計畫、門住診費用比例、地區醫院

關鍵字

醫院卓越計畫 ； 門住診費用比例 ； 地區醫院

並列摘要

Abstract
Under the concepts of hospital individual budget and hospital self-management of hospitals, Center of Excellence Plan guides hospitals to replace competition by cooperation and to reduce the innovation risks. In order to correct hospitals’ management principle in focusing on outpatient services but disregarding inpatient ones, the plan concludes outpatient and inpatient services ratio as the necessary index. This study is mainly to confer how Hospital Excellence Plan influences Outpatient-Inpatient Expenditure Ratio and medical treatment. Compiling statistics and analyzing from 49 hospitals of Central, Region Branch, Bureau of National Health Insurance, who have implemented Hospital Excellence Plan since July 1st 2004.
The study discovers:
1. After implementing Excellence Plan, though the hospital adjusts Outpatient-Inpatient Expenditure Ratio by inner management and control, the outpatient expenditure ratio still could not lower to 45% in district hospitals; furthermore, the outpatient expenditure ratio of 22 district hospitals is more than 50%, which will cause double loss of outpatient and inpatient expenditure to district hospitals and influence their medical operation.
2. The outpatient counts and cases of all hospitals are fewer, especially of district hospitals; however they still could not reach the target value of Outpatient-Inpatient Expenditure Ratio, which reveals the regulation of 45%: 55% Outpatient-Inpatient Expenditure Ratio is a mission uneasy to achieve for district hospitals.
3. 66% reduced outpatient count of Hospital 16 in medical center is for medicine expenses, and 34% of it is for other outpatient services. Though the outpatients’ medicine expenses in Hospital 8 are reduced, other outpatient expenditures are increased. Above condition reveals that the inner management and control of these two hospitals are very different from each other.
4. Of the reduced outpatient counts, medicine expenses share 61% in regional hospitals, and 69% in district hospitals, which reveals Center of Excellence Plan could appropriately manage and control medicines more and improve the wasted condition.
5. After implementing Center of Excellence Plan , the outpatient operation cases are fewer than before in all hospitals; however outpatient operation counts are more. Both inpatient counts and cases increased, but there is no any obvious information shows that the hospitals turn outpatient operation to inpatient operation. Further conference should be done for tracing the condition.
The regulation of Outpatient-Inpatient Expenditure Ratio is incapable to completely control the overhigh outpatient service ratio. Only cooperate with graded referral system, graded medicines expenses share system, open medical information system and health education propaganda could effectively control outpatient medical expenses.

Key words: Center of Excellence Plan , Outpatient-Inpatient Expenditure Ratio and district hospitals

並列關鍵字

Center of Excellence Plan ； Outpatient-Inpatient Expenditure Ratio ； district hospitals

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