評估脊椎融合術納入全民健保診斷關聯群對醫療費用影響因子分析

Factor Analysis of Medical Expenses Surrounding Spinal Fusion Surgery Under Tw-DRGs

郭靜燕(Ching-Yen Kuo) ； 潘人豪(Ren-Hao Pan) ； 陳麗資(Li-Zi Chen) ； 陳厚全(Hou-Chaung Chen) ； 詹前隆(Chien-Lung Chan)

《醫學與健康期刊》 5卷2期 (2016/09) Pp. 57-71

摘要

目的：瞭解某醫院脊椎融合術導入疾病診斷關聯群(Tw-DRGs)後醫療費用盈虧分布情形，並探討病人特性對脊椎融合術導入Tw-DRGs後損益之影響。方法：以健保署公告3.4版Tw-DRGs，試算某醫院2010-2013年脊椎融合術住院案件醫療點數分布，分析病人特性對脊椎融合術是否虧損之影響，以卡方檢定、多變項邏輯斯迴歸進行統計分析。結果：住院案件共有778筆落入健保DRG脊椎融合術範圍，其中以DRG_49702(後側及其他脊椎融合術無合併症或併發症)件數最多，共532件，損益率為-0.5%。年齡平均為63歲，男性佔41%、女性佔59%。住院天數平均9.3天，醫療費用最大值為348,641點，最小值為65,757點，平均為136,490點，虧損案件有124件(23.3%)，無虧損案件408件(76.7%)結論：年齡大於65歲、腰部閉鎖性骨折、脊柱側凸及脊柱後側凸、住院天數大8日、有人工植入物容易虧損。本研究結果可協助醫院進行脊椎融合術醫療費用之監控，並做為健保署對脊椎融合術納入Tw-DRGs分類之參考。

關鍵字

診斷關聯群 ； 脊椎融合術 ； 醫療費用

並列摘要

Objectives. To understand the medical expenses, the distribution of profits and losses, and the effect of patient characteristics after including spinal fusion surgery into Taiwan Diagnosis-Related Groups(Tw-DRGs). Methods. Using the 3.4 version of Tw-DRGs, we simulated the distribution of cost points for hospitalized cases for spinal fusion surgery in one metropolitan hospital between 2010 to 2013 to analyze the profit and loss effects by patient characteristics after introducing the spinal fusion surgery into Tw-DRGs. Chi-square and the multivariate logistic regression statistical analysis was used to test the differences. Results. A total of 778 cases required spinal fusion surgery based on Tw-DRGs ranges. 532 cases were categorized as DRG_49702, the largest group targeted. Loss rate was -0.5%. The average age was 63 years old. Forty-one percent were male, and 59% female. The average number of days hospitalized was 9.3 days. The maximum medical expense was 348,641 in cost points, the minimum 65,757. Average medical expense was 136,490 points. One hundred twenty-four (23.3%) were classified as loss cases, 408 (76.7%) non-loss. Conclusion. Loss was more likely when patients were older than 65 years with a close fracture of lumbar, kyphoscoliosis or scoliosis and more than eight days of hospitalization with artificial implants. It was concluded that it would help hospitals if they monitored the expenses of spinal fusion surgery. It is hoped that this study can be used as a reference for the NHI Administration as they introduce spinal fusion surgery into Tw-DRGs.

並列關鍵字

Spinal fusion surgery ； Diagnosis related groups(DRGs) ； Medical expense

參考文獻

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羅郁婷、張冠民、董鈺琪(2015)。DRG為基礎前瞻性支付制 度對覽關節骨折置換術的醫療利用與照護結果之影響。臺灣衛誌。34，180-92。

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中央健康保險署：Tw-DRGs支付分類表。http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=710&WD_ID=812&webdata_id=4671引用6//23/2016。National Health Insurance Administration: Tw-DRGs payment classification. Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=710&WD_ID=812&webdata_id=4671. Access Mar 24, 2016. [In Chinese]

中央健康保險署：Tw-DRGs分類表4.0版。http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&WD_ID=1036&webdata_id=4965引用3//24/2016。National Health Insurance Administration. Tw-DRGs payment classification 4.0 Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&WD_ID=1036&webdata_id=4965.Access Mar 24, 2016. [In Chinese]