美國長期呼吸器依賴患者健康照護給付制度－以Medicare與Medicaid為例

Health Care System for Long-Term Ventilator-Dependent Patients in The

吳帆(Fan Wu) ； 羅家倫(Chia-Lun Lo) ； 劉美文(Mei-Wen Liu) ； 王淑莉(Shu-Li Wang)

《呼吸治療》 10卷1期 (2011/01) Pp. 79-90

https://doi.org/10.6269/JRT.2011.10.1.07

摘要

依據全民健康保險統計資料顯示，因呼吸衰竭需長期呼吸器使用的重大傷病患者之實際有效領證數，截至民國93年已達10,551人，其所使用之醫療費用，截至民國93年已高達153億元，佔健保總醫療費用的26.24%，在健保費開源不易之情形下，爲促使醫療資源有效應用，支付制度改革是勢在必行。
本文以美國Medicare及Medicaid爲例，整理有關其健保制度並儘可能詳述美國在各層級醫療機構中長期呼吸器依賴患者之醫療照護支付方式，該國主要以診斷關係群組(Diagnosis Related Groups)與整合式醫療(Integrated Deliever System (IDS)方式給付呼吸器依賴患者之醫療費用，亦有依治療時程漸次下轉(step down)與避免醫院互轉等防止醫療浪費的措施給付，透過具彈性的配套方式來達到降低醫療費用的成長率及維護長期呼吸器依賴患者之醫療品質水準。
最後本文建議我國可參採美國在IDS制度下，再加上DRG的給付分類，減低醫療院所承受的醫療風險，以期提高長期呼吸器依賴患者之照護品質，並確保照護機構有適當的給付。

關鍵字

長期呼吸器依賴 ； 整合式照護 ； 整合系醫療照護系統 ； 給付制度 ； 呼吸器

並列摘要

According to the statistical data of the National Health Insurance, Taiwan, the number of patients with the heavy-disease card since of the respiratory failure is up to 10,551 in the year of 2004, and the corresponding expenditure for them is up to 15.3 billion, which occupies 26.24% of the total expenditure of NHI. For effective utilization of the limited health-care resource, the reforming of the payment system for the respiratory patients is needed.
This research surveys, interviews and collects the payment system, reports and the care protocol and payment for the Prolonged Mechanical Ventilation (PMV) of the US, from the literature and the health bureaus' Web sites. The payment system of US for PMV is the most complete one that their payment system is prospective payment system; that is, the global budget associated DRG system; in addition, this payment system has mechanism to encourage the step-down delivery and to prevent the multi-referral of the PMV between hospitals.
The research suggests the Bureau of Natiaonal Health Insurance of Taiwan can adopt the payment system of US, which is an integrated delivery system with the help of DRG. This system can reduce the risk afford by the hospitals and increase the care quality of PMV and ensure the hospitals able to get the appropriate payment in their caring.

並列關鍵字

Prolonged mechanical ventilation ； Integrated delivery system ； Payment system ； Ventilation