Tw-DRGs制度下醫院費用損益與住院日數相關性探討－以某地區教學醫院為例

Correlation between Hospital's Profit and Loss Rate and Length of Stay in the Tw-DRGs Payment System: A Case Study of a District Teaching Hospital

李培芬(Pei-Fen Lee)

《醫療品質雜誌》 12卷1期 (2018/01) Pp. 58-67

摘要

目的：Tw-DRGs個案損益率及超期率之相關研究，探討醫院因應支付制度改變之策略。材料及方法：以個案醫院健保申報資料，申報明細與Tw-DRG分類表串檔，分析MDC別、Tw-DRGs別、落點、損益率、超期率相關性。結果：MDC8個、18個科別、Tw-DRGs154個；16.1%落點在虧損區佔率不高，多數落在溢酬區。69.6%小於等於幾何平均住院日數佔多數。無論在4個落點或8個MDC間，損益率與超期率皆有顯著差異。各Tw-DRG超期率與損益率75%有顯著相關性。Pearson分析超期率與損益率二者之間具有顯著相關性。結論：損益率越低者超期率越高。損益結果與檢查、處置碼等因素亦十分相關。住院診療品質並未因醫療資源耗用少或住院日數縮短而降低。縮短住院日數會相對提高病床利用率，不論是否能得到溢酬，皆有助於醫療資源的有效利用，轉而提升醫療照護品質。

關鍵字

臺灣版全民健保住院診斷關聯群 ； 主要疾病類別 ； 落點 ； 損益率 ； 超期率

並列摘要

Objective: To study the relationship between the profit and loss rate and the overdue rate of Taiwan diagnosis related groups (Tw-DRGs) cases and to explore strategies for changing the hospital's payment system. Materials and Methods: Based on hospital health insurance data and the Tw-DRG classification table, the correlations between major disease categories(MDCs) and other Tw-DRGs, location, profit and loss rate, and overdue rate were analyzed. Result: Eight MDCs, 18 patients, 154 Tw-DRGs; 16.1% in the loss zone, mostly in the premium area. 69.6% less than or equal to the geometric average number of hospitalizations accounted for the majority. In 4 locations and 8 MDCs, profit and loss rates and overdue rates were significantly different. Tw-DRG overtime rate and profit and loss rate were significantly correlated. There was a significant correlation between the overdue and profit and loss rates in Pearson analysis. Conclusion: Lower profit and loss rates are associated with a higher overdue rate. Inspection, procedure code, and other factors are also related to profit and loss. The quality of hospitalization did not decrease due to fewer medical resources or shorter hospitalization. Shortening hospitalization will improve the availability of hospital beds, regardless of whether premiums are available, and contribute to the effective use of medical resources, thus enhancing the quality of medical care.

並列關鍵字

Taiwan diagnosis-related groups ； major disease categories ； placement ； profit and loss rate ； overdue rate