「糖尿病醫療服務改善方案」試辦計畫對第二型糖尿病人醫療資源利用之影響

The Impact of Pay-for-Performance Program on the Medical Utilization of Type 2 Diabetes in Taiwan

侯佳雯(Chia-Wen Hou)

指導教授 ： 薛亞聖

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2005年)

https://doi.org/10.6342/NTU.2005.01898

摘要

中央健保局自民國90年11月起，實施「糖尿病醫療服務改善方案」試辦計畫，希望藉由調整支付醫療機構費用的方式，鼓勵醫事人員進行糖尿病的預防、診斷、治療、控制與自主管理教育，提供具效益與完整性的服務項目，使糖尿病人之病情得到良好控制，以減少糖尿病人的醫療費用與不必要的醫療資源利用。因此，本研究的目的旨在探討「糖尿病醫療服務改善方案」試辦計畫對第二型糖尿病人醫療資源利用之影響。
　　研究中以第二型糖尿病人為對象，採用實驗組與對照組相較之方式進行研究，並選擇另一組對照組作為參考組，與實驗組進行比較分析，以避免選樣誤差的情形發生。本研究以試辦計畫之收案病人為實驗組，而就診於加入試辦計畫之醫療機構的非收案病人為對照組，就診於未加入試辦計畫之醫療機構的糖尿病人則為參考組；資料來源為90年、91年「健保資料庫」之次級資料，並運用差異中之差異法與迴歸分析方法，探討試辦計畫實施後，第二型糖尿病人醫療資源利用的改變。
　　本研究主要結果如下：
一、試辦計畫實施後，對第二型糖尿病人醫療利用之影響：
1. 加入「糖尿病醫療服務改善方案」試辦計畫醫療機構之收案病人，其年度規定之七項檢驗之檢驗率，較加入與未加入試辦計畫醫療機構之非收案病人高。
2. 加入「糖尿病醫療服務改善方案」試辦計畫醫療機構之收案病人，其門診利用的增加，較加入與未加入試辦計畫醫療機構之非收案病人多。
3. 加入「糖尿病醫療服務改善方案」試辦計畫醫療機構之收案病人，其急診利用的增加，較加入試辦計畫醫療機構的非收案病人少，但較未加入試辦計畫醫療機構的非收案病人多。
4. 加入「糖尿病醫療服務改善方案」試辦計畫醫療機構之收案病人，其住院利用的增加，較加入試辦計畫醫療機構的非收案病人少，而與未加入試辦計畫醫療機構的非收案病人沒有差異。
二、試辦計畫實施後，對第二型糖尿病人醫療費用之影響：
1. 加入「糖尿病醫療服務改善方案」試辦計畫醫療機構之收案病人，其門診費用、急診費用、住院費用與總醫療費用的增加，較加入與未加入試辦計畫療機構的非收案病人少整體而言，本研究發現，「糖尿病醫療服務改善方案」試辦計畫確實可減緩其收案病人之醫療費用的增加，且提升收案病人接受必要檢驗之檢驗率。因此，本研究建議：
1. 繼續實施「糖尿病醫療服務改善方案」試辦計畫，並且鼓勵醫療機構加入此試辦計畫。
2. 醫療機構將所有糖尿病人皆納入「糖尿病醫療服務改善方案」試辦計畫之收案病人。一方面可以得到完整的給付費用，另一方面，也可以給予所有糖尿

關鍵字

糖尿病 ； 糖尿病醫療服務改善方案 ； 醫療資源利用 ； 差異中之差異

並列摘要

Pay-for-Performance Program has been put into practice since September 1, 2001. The program was designed to reduce the expenditure growth of diabetes mellitus and control diabetes by providing complete care for diabetics. The purpose of this research was to evaluate the impact of Pay-for-Performance Program on the medical utilization of type 2 diabetes in Taiwan.
This study observed type 2 diabetics’ medical utilization for two years before and after the introduction of Pay-for-Performance Program. It was a case-control study. The study group were the type 2 diabetics who were the participators of the Pay-for-Performance Program, and the control group were the type 2 diabetics who were not the participators of the Pay-for-Performance Program. Besides, in order to avoid selection bias, there was a compare group. The compare group were the type 2 diabetics who receive medical care for diabetes at the hospitals didn`t participate the Pay-for-Performance Program. This study used claimed data of Nation Health Insurance and Department of Health from 2001 to 2002 for analysis. The ‘‘difference-in diffenence’’ methodology and polynomial regression were used for statistic analysis.
The main findings of this study were concluded as below:
1. The impacts of type 2diabetics medical utilization:
(1) After Pay-for-Performance Program was put into practice, the rates of the study group to accept the annual seven necessary examines increased.
(2) Compared to the control group and compare group, the study group had a significant increase on ambulatory care visits.
(3) Compared to the control group, the study group had a significant decrease on emergency care visits, but had a significant increase when comparing to the compare group.
(4) Compared to the control group, the study group had a significant decrease on length of stay, but there was no significant effect between the study group and the compare group.

2. The impacts of diabetics medical expenditure:
(1) Compared to the control group and compare group, the study group had a significant decrease on ambulatory expenditure, emergency expenditure, hospitalization expenditure, and total medical expenses.
This study found the study group decreased the total medical expenses, and increased the rates of the study group to accept the annual seven necessary examines under the Pay-for-Performance Program. Therefore, this study suggests:
1. It is appropriate to maintain the current Pay-for-Performance Program.
2. All of the type 2 diabetics can be included to the Pay-for-Performance Program, and receive complete care for diabetes.

並列關鍵字

Diabetes ； Pay-for-Performance Program ； Medical Utilization ； Difference-in-Difference

參考文獻

中央健保局. (2001). 全民健保糖尿病醫療給付改善方案試辦計畫支付標準.

中央健保局. (2005). 糖尿病專業醫療服務品質報告.

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