診斷關係群決策支援系統開發與評估

Development and Evaluation of the Decision Support System for Diagnostic Related Groups

周鶴庭(jou hau ting)

指導教授 ： 呂克明

亞洲大學/資訊學院/資訊工程學系碩士班/碩士(2007年)

摘要

1995年3月台灣全民健保開辦，已降低人民就醫上的經濟問題，增加全民醫療可近
性，逐步達到保障人人公平就醫目標。但在維持保險財務平衡及醫療資源有效利用
上卻面臨公勞保時代一樣的挑戰。（江東亮、張睿詒，1998）。
世界衛生組織於1999年提出醫療提供者除需承擔提供醫療服務之風險，亦需承擔起
醫療財物的風險，將財務風險轉移給醫療服務提供者已經成為世界潮流（WHO，
1999）。
全民健保醫療費用隨總額預算制度實施，將全面控制在某個成長範圍內，未來醫院
所收健保給付將受到總額限制很難大幅成長（邱永仁，1999）。
隨著醫療費用逐年上漲，藥品費用也成正比上漲。中央健康保險局為了抑制不斷上
漲的醫療費用，陸續實施轉診制度、增加部份負擔、診斷關係群(DRGs)支付制度、
醫院自主管理及總額預算支付制度等措施。
醫院為了生存，控制成本勢在必行，控制成本又要兼顧品質與效率，首重醫院之經
營管理策略，透過醫院內部的組織管理整合與作業規範，減少無形、有形之浪費。
在DRGs、總額預算支付制度相繼實施後，對中央健康保險局而言是控制了費用，
但對醫院來說競爭更加激烈。如何有效降低費用及控制成本，而不影響醫療品質及
效率，才是醫院資訊管理中最重要的問題。
本研究是期望發展出一套診斷關係群決策支援系統，來協助疾病分類人員對於主要
診斷分類代碼的選擇，降低分類過程中所需花費的時間及成本，目前面對健保局採
行診斷關係群(DRGs)支付制度為住院醫療給付制度，提高疾病分類編碼品質運用資
訊科技作為輔助是唯一的選擇，相對亦可提升醫院競爭力。

關鍵字

全民健康保險、診斷關係群、總額預算、診斷關係群決策支援系統

並列摘要

Taiwan’s National Health Insurance started in March 1995, has reduced the financial
problems of people seeking medical treatment, increased medical treatment for everyone,
and reached the goal of fair medical treatment for everybody step by step. But it’s facing
the same challenges like the Government Employees' Insurance and Labor Insurance era
(Dong-Liang Zhang, Ru-I Chang, 1998).
The World Health Organization announced that medical care providers also need to take
the risk of medical properties besides taking the risk of providing medical service in 1999.
It’s a world trend transferring the financial risks to the medical service providers (WHO,
1999).
Along with the implementation of the total budge system, the cost of National Health
Insurance will be in a fully controlled growing range, and the NHI payments for the
hospitals will have difficulty growing substantially with the limitation of the total budget
system (Yeong-Jen, Cho, 1999).
With the increasing costs of health care, the cost of drugs is also increasing in the same
proportion. In order to restrain the rising medical cost, the Central Health Insurance
Bureau has implemented the referral system, partial cost increase, Diagnosis Relation
Groups (DRGs) payment systems, hospital self management and total budget payment
system.
In order to survive, hospitals must control costs. So as to control costs and maintain
quality and efficiency, the hospital management strategy will be the most important key
point. And through the integration of hospital internal organization and operation
standards, it can reduce invisible and visible waste.
After implementing the DRGs and total budget payment system, for the Central Health
Insurance Bureau, the cost has been under control, except for the hospitals, the
competition has become more intense. It is the most important issue for hospital
v
information management to not affect the medical quality and efficiency and also reduce
and control costs in an efficient way.
This study expects to develop a Diagnosis Relation Groups Decision Support System, to
assist disease classification officers to choose the primary diagnosis classification codes,
and reduce the required time and cost during the classification process.
Currently when facing Central Health Insurance Bureau using DRGs payment system as
a hospital care payment system , hospital use information technology as the only choice
to increase disease classification coding quality and at the also enhance the
competitiveness of the hospital.

並列關鍵字

National Health Insurance, Diagnosis Relation Groups, Total budget, Diagnosis Relation Groups Decision Support System

參考文獻

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