醫院總額支付制度對住診醫療品質之初步影響

The Preliminary Impact of Hospital Global Budgeting on the Quality of Inpatient Care

羅紀琼(Joan C. Lo) ； 尤素娟(Suchuan Yu)

《台灣公共衛生雜誌》 29卷4期 (2010/08) Pp. 360-368

https://doi.org/10.6288/TJPH2010-29-04-09

摘要

目標：本研究旨在探討全民健康保險醫院總額支付對住診醫療品質的初步影響。方法：以迴歸分析的方式探討在控制病患的疾病嚴重度及自主與卓越計畫的參與後，於2002年7月開始實施的醫院總額支付對病患住院30日內死亡機率、出院後30日內再住院機率及感染機率的影響。採用的資料為2000至2004年全民健康保險住院明細及衛生署之死因檔。結果：在醫院總額支付制度實施後，私立地區醫院（參考群）病患的再住院機率顯著減少，感染機率沒有顯著變化，死亡機率則顯著降低。與私立地區醫院比較時，公立及財團法人醫院的再住院機率顯著降低，感染機率顯著增加；醫學中心與區域醫院的再住院機率顯著增加，感染機率顯著降低。公立及區域醫院的死亡率也顯著降低。結論：醫院總額的實施對病患的再住院機率、感染機率與死亡機率在醫院層級及權屬間有不同的影響方向。整體而言，醫療品質有改善態勢。

關鍵字

醫院總額 ； 總額支付 ； 醫療品質

並列摘要

Objectives: To investigate the preliminary impact of hospital global budgeting on the quality of inpatient care. Methods: Hospital inpatient claims from 2000 to 2004 and cause of death files were utilized. After adjusting for patients' co-morbid conditions and hospitals' participation in self-control programs, regression analysis was employed to explore the quality of inpatient care as manifested by mortality 30 days after admission, readmission 30 days after discharge and rates of infection. Results: After the implementation of hospital global budgeting, patients in private district hospitals had significantly lower readmission and mortality rates. Compared to patients in private district hospitals, patients in public and not-for-profit hospitals had significantly lower readmission rates but higher infection rates; patients in medical centers and regional hospitals had significantly lower rates of infection but higher readmission rates. Conclusions: The implementation of the hospital global budgeting system by NHI had a differential impact on different types of hospitals with regard to patient readmissions and infection and mortality rates. Generally speaking, the quality of care has improved.

並列關鍵字

hospital global budget ； global budgeting ； quality of care

參考文獻

莊逸洲、黃崇哲、魏明智(2003)。台灣醫院總額支付制度運作模式的初步探討。醫務管理。4，1-17。

羅紀琼、詹維玲(2007)。醫院總額預算對費用單價與服務量的影響初探。台灣衛誌。26，261-269。

Organization for Economic Co-operation and Development (OECD). OECD health data 2009: statistics and indicators for 30 countries. Available at: http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html. Accessed October 6, 2009

行政院衛生署：全民健康保險醫院總額支付制度品質確保方案。http://www.doh.gov.tw/ufile/ doc/960327附件二公告醫院品質確保方案附件.pdf。引用2009/09/20。

Canadian Institute for Health Information. Waiting time tables - a comparison by province, 2007. Available at: http://cihi.ca/cihiweb/en/downloads/aib_provincial_wait_times_e.pdf. Accessed 2009/10/09.