全民健保物理治療支付之調查研究

A Survey of Physical Therapy Reimbursement in National Health Insurance

王瑞瑤(Ray-Yau Wang) ； 李雪楨(Hsuei-Chen Lee) ； 李淑貞(Shwn-Jen Lee) ； 熊嘉玲(Chia-Ling Hsiung) ； 陳麗妃(Li-Fei Chen)

《中華民國物理治療學會雜誌》 24卷5期 (1999/09) Pp. 364-371

https://doi.org/10.29616/JPTAROC.199909.0005

摘要

本研究目的為了解全民健保物理治療給付申報、核減及申復情形，及調查對物理治療支付制度之意見。以問卷方式進行，由健保局所列各級特約醫療院所中有列復健科目或復健業務之院所，為問卷寄發對象，共計169所，請其由申報物理治療健保業務負責人填寫問卷，回收55份，回收率為32.5%，其中不清楚健保申報審查程序或標準佔43.6%，而有八成不同意專業審查之合理性及適當性，認為健保現行物理治療支付標準有調漲祕要者佔92.7%，在門診及住院病患治療部份，簡單－中度治療為最常申報之物理治療項目，區域醫院之核減率較低，在門診中最常被核減之項目為簡單－中度，但複雜治療則為住院病患治療中最常被核減之項目，而申復成功率亦以區域醫院較高，以基層院所較低。本研究顯示，目前健保物理治療給付、審查及申復方面，尚有很大改善空間。

關鍵字

支付 ； 物理治療 ； 全民健保

並列摘要

The purpose of the study is to investigate the claim, denial and appeal of rimbursement system of National Health Insurance. Questionaires were mailed to the hospitals and clinics which provided physical therapy services. Fifty-five hospitals/clinics responded to our questionaire. The responding rate was 32.5%. Among the respondents, 24 (43.6%) did not know about the process or the standard of the claim system. Eighty percents did not agree that the professional review is reasonable or feasible. Most of the respondents (92.7%) suggested that the reimbursement of physical therapy should be higher. ”Simple to moderate” physical therapy treatment procedures were the most frequently claimed item in both outpatient and inpatient services. The most frequent denied item was ”simple to moderate” in outpatient physical therapy department. While the ”complicated” treatment was the most frequent reduction item in inpatient physical therapy services. The successful rate for appeal was higher in ”area hospital”, and was lower in clinics. According to our results, the National Health Insurance should provide better claim, denial and appeal system in the reimbursement of physical therapy services.

並列關鍵字

Reimbursement ； Physical therapy ； National health insurance