定額支付的病例醫令項目之合理性研究

Identifying Interesting Patterns in a Medical Database System-Fixed Amount Payment's Order Items

蔣肇慶(Jaw-Ching Chiang) ； 林熙禎(Shi-Jen Lin)

《資訊管理學報》 12卷1期 (2005/01) Pp. 215-240

https://doi.org/10.6382/JIM.200501.0215

摘要

全民健康保險制度是自給自足的社會保險制度。因而，對於醫療給付單位及醫療院所而言，在有限的醫療給付資源情形之下，必須建立醫療的收支平衡，方為持續經營之道。醫療給付單位為有效的控制醫療費用，實施總額預算制的醫療給付制度，其目的在協助醫療院所能有效的規劃醫療資源、控制醫療成本及提昇服務品質。在總額預算制度之定額支付的病例，醫令執行項目內容的問題，可以藉著醫令合理性予以適當的解決。因此，本研究提出一個ART_N.V.計劃，藉由修改後之關連式規則與值比率的組合，將定額支付下之疾病醫令項目，實驗得出基本醫令群。此基本醫令群不但可以協助醫療給付單位，更精確的計算出病例的必須執行醫令項目及支付的費用；而且在醫療院所方面，可以節省不必要的處置與成本支出，提升營運的績效。此研究論證定額支付的病例之醫項目及支付的費用，作為目前及未來在定額支付之下病例開立醫令的參考。

關鍵字

基本醫令群 ； 值比率 ； 定額支付

並列摘要

Maintaining a financial balance given limited medical payments is essential for health insurance payment units and hospitals. The Bureau of National Health Insurance (BNHI) implemented the Prospective Payment System of the Global Budget System to assist hospitals in planning and controlling medical care costs and service quality. Meanwhile, the BNHI also devised various plans for strengthening the operational utilization of medical resources. This study suggests the ART_N.V. scheme for computing Basic Order Groups (BOG) and assessing their costs/benefits in a Fixed Amount Payment System. The BOGs used to provide a contrast in the experiment are more savings in medical care costs than health insurance reporting payments. Therefore, the BOG can not only assist payment units in reducing costs, but also can assist hospitals in operating efficiently using the Fixed Amount Payment System. Consequently, this study demonstrates a standard of payment for current and future basic and suitable order items of Fixed Amount Payment system references.

並列關鍵字

Basic Order Group ； Value Rate ； Fixed Amount Payment system

參考文獻

Agrawal, Rajesh,Ramakrishnan Srikant(1994).Proceedings of the 20(superscript th) VLDB Conference.Santiago, Chile.

Birkhoff, G.(1967).lattice Theory.Providence, R.I.:Am Math. Soc., Colloquium Publication.

Chaudhuri, Surajit,Umeshwar Dayal(1997).An Overview of Data Warehousing and OLAP Technology.

Chiang, Jaw-Ching,Shi-Jen Lin(1999).A Study of Data Mining Medical Informatics.The Journal of China Association for Medical Informatics.9,71-82.

Chiang, Jaw-Ching,Shi-Jen Lin(2002).The Model of Payment System under Case Payment-APORES Model.The Journal of Taiwan Association for Medical Informatics.14,1-16.