疾病管理對糖尿病患醫療資源耗用之影響

Disease Management and Its Effects on Resource Utilization Diabetic Patients

黃三桂(San-Quei Huang) ； 王悅萍(Yueh-Ping Wang) ； 錢慶文(Ching-Wen Chien)

《醫務管理期刊》 3卷2期 (2002/06) Pp. 35-48

https://doi.org/10.6174/JHM2002.3(2).35

摘要

為了平衡全民健康保險保險財務及增加就醫可近性，以達到提高醫療品質等目的，健保局自民國九十年十月起開始誰動「醫療給付改善方案試辦計劃」，以糖尿病等五大疾病為主，試將醫療品質和醫療保險給付的提高作妥善的結合。這種「論質計酬」給付方式的效果如何其實是建立在「疾病管理」是否有效果的基礎上。有鑑於此，本研究即以「桃園縣糖尿病共同照護網」（疾病管理）為例，探討以健保來主導的「疾病管理」之效果一對糖尿病病患醫療資源耗用之影響，藉以了解「論質計酬」支付制度未來擴大實施的可行性。
由於資料來源之限制，本研究以桃園縣糖尿病患者在照護網實施前後各半年之健保門、住診醫療費用為例，將病患區分出參與照護網（認證組2,517位）與未參與照護網（非認證組41,474位）兩組病人後，利用t和paired-t檢定來檢定認證組和非認證組在誰動糖尿病共同照護網前後醫療資源耗用的差異，並以逐步複迴歸分析探討病人特質，性別和年齡，對糖尿病病患醫療資源耗用之影響。
本研究之結果顯示健保局主導的疾病管理對醫療資源在質和量的影響是有正面的，因為：1、認證組的醫療資源耗用在質、量及項目上均獲得合理的控制。2、病患的特質如性別及年齡對醫療資源的耗用影響力無關鍵性之影響。
此外，本研究建議未來健保局因當思考如何將更多的醫療品質指標納入相類似的研究使健保局在誰動以「疾病管理」為基礎的「論質計酬」給付方式更具有說服力。

關鍵字

疾病管理 ； 糖尿病共同照護網 ； 論質計酬

並列摘要

To balance financial viability, accessibility and quality of medical services, the National Health Insurance Bureau (NHIB) has implement an experimental project focusing on consistency of medical care quality and reimbursement since October, 2001. Five major Taiwanese diseases, including diabetics, are subjects of this experiment. The success of this new pay-by-quality experiment is based upon the effectiveness of disease management programs, Therefore, the aim of this study is to assess the effectiveness of a disease management program the Diabetics Care Network of Taoyuan County (DCNTC), and evaluate the appropriateness of expanding similar experiments.
Claim data of 2,517 DCNTC participants and 41,747 non-participants were analyzed by using independent t and paired t-tests. Stepwise Regressions were also used to assess the influence of patient characteristics, age and gender, on health care resource consumption by participants and non-participants of the DCNTC. Results of the study indicate: 1. The quantity, quality and types of healthcare resources consumed by participants of the IXNTC were controlled, and 2. Patient characteristics only had minor impact on the quantity of health care resource consumed by participants and non-participants of the DCNTC. These findings indicate that the NHIB's experiment (the disease management program) is successful although the effects of many factors, such as organizational characteristics, were not included in the study. Therefore, future studies related to this subject should include more quality indicators.

並列關鍵字

Disease Management ； Diabetics Caring Network ； Pay-by-quality

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