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  • 學位論文

探討疾病嚴重度對Tw-DRGs醫療費用解釋力的影響─以呼吸系統之疾病與疾患為例

The Effect of Severity on the Explanation of Tw-DRGs Medical Expenditures– An Example of Diseases and Disorders of the Respiratory System.

指導教授 : 黃偉堯

摘要


研究背景:為了抑制醫療費用上漲的速度,台灣從2010年以診斷關聯群支付醫院住院費用,利用財務誘因促使醫療提供者提升效率與降低成本。疾病嚴重度是診斷關聯群中重要的分類因素,且在醫療費用解釋力方面仍有改善空間。 研究目的:以MS-DRGs疾病嚴重度分類方式取代Tw-DRGs3.0版疾病嚴重度分類方式,模擬醫療費用的解釋力。 研究方法:本研究為橫斷式的模擬研究,以國家衛生研究院發行的2008年「全民健康保險研究資料庫」中的次級資料:「醫事機構基本資料檔」、「住院醫療費用清單明細檔」進行分析。參照Tw-DRGs3.0版與MS-DRGs的疾病嚴重度分類方法,針對Tw-DRGs3.0版之MDC4呼吸系統疾病與疾患進行分類,比較兩種分類方式的住院醫療費用解釋力(R平方)以及各DRGs碼的相對權重值(RW)。此外,排除醫療費用極端值後,再次進行醫療費用解釋力分析。 研究結果:Tw-DRGs3.0版之MDC4依照Tw-DRGs3.0版之疾病嚴重度分類後,醫療費用解釋力為0.4566,依照MS-DRGs之疾病嚴重度分類後,醫療費用解釋力為0.4759,提升醫療費用解釋力4.23%。排除醫療費用極端值後,Tw-DRGs3.0版疾病嚴重度分類的醫療費用解釋力為0.5177;MS-DRGs版疾病嚴重度分類的醫療費用解釋力為0.5334,提升醫療費用解釋力3.03%。此外,疾病嚴重度分類改變後,43個BaseDRGs碼中,38個RW值差距變大;排除醫療費用極端值後,39個RW值差距變大,顯示資源耗用相近的病患分類更集中。 結論:疾病嚴重度分類改變後,對於Tw-DRGs3.0版的住院醫療費用解釋力有影響。針對Tw-DRGs3.0版之MDC4呼吸系統疾病與疾患的疾病嚴重度分類,從Tw-DRGs3.0版的兩層改為MS-DRGs的三層後,提升醫療費用解釋力。

並列摘要


Background:In order to control the rising medical expenditures, the Taiwan Diagnosis Related Groups (Tw-DRGs) was implemented since 2010 to pay for hospitalization expenses, creating financial inducements to encourage healthcare service providers to improve efficiency and to reduce costs. Diseases severity is an important classifying factor in the DRGs classification system, and the explanation of medical expenditures is still having improvable space. Objective: This study aims to use the classification of severity of MS-DRGs to replace the classification of severity of Tw-DRGs version 3.0, so as to simulate the explanation of medical expenditures. Design: This study is a cross-sectional, simulated study. Secondary data was collected from the National Health Insurance Research Database in 2008, including two groups of claims data: Registry for Contracted Medical Facilities and Inpatient Expenditures by Admissions. Patients with respiratory diseases and disorders in the Major Diagnosis Category 4 (MDC4) of Tw-DRGs version 3.0 were categorized based on the severity classification systems of Tw-DRGs version 3.0 and of MS-DRGs respectively. This study calculated and compared the explanation of medical expenditures and the related weights (RW) of the two aforementioned severity classification systems. Furthermore, this study eliminated the outliers of medical expenses, and analyzed again the explanation of medical expenditures. Results: When classifying patients in the Major Diagnosis Category 4 of Tw-DRGs version 3.0 using the severity classification systems in Tw-DRGs version 3.0, the explanation of medical expenditures was 0.4566. Meanwhile, adopting the severity classification system of MS-DRGs resulted in an explanation of medical expenditures of 0.4759, with an increase of 4.23%. After trimming the outliers of medical expenses, the explanation of medical expenditures when adopting the severity classification system of Tw-DRGs version 3.0 was 0.5177 whereas the explanation of medical expenditures was 0.5334 when adopting the MS-DRGs severity classification system, with an increase of 3.03%. Moreover, 43 BaseDRGs altered the severity classification system, 38 RW of BaseDRGs increased deviations; After trimming the outliers of medical expenses, 39 RW of BaseDRGs increased deviations, the result showed a more centralized classification of patients with similar resource consumptions as. Conclusion: The alteration of severity classification systems had impact on the explanation of hospitalization expenses of Tw-DRGs version 3.0. In terms of patients in the Major Diagnosis Category 4 of the Tw-DRGs version 3.0, the change from the two-level classification system of Tw-DRGs version 3.0 to the three-level MS-DRGs system has improved the explanation of medical expenditures.

參考文獻


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被引用紀錄


陳偉哲(2016)。Tw-DRGs支付制度對於醫療資源耗用之影響探討- 以南部某區域教學醫院 DRG 23402為例〔碩士論文,義守大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0074-2407201613471300

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