探討實施DRGs 制度對醫院醫療費用之可能影響-以台中縣市醫院為例

The impact of DRGs System to the Hospital Payment under NHI Scheme-Hospitals on Taichung area as an Example

廖錦珍(liao chin chên)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

支付制度改革，是多數國家用以增進醫療效率、提升醫療品質、節制醫療費用常用之方法。我國自民國八十四年三月一日開始實施全民健保，至今多次改革支付方式，並計劃自民國97年1月起在總額支付制度下實施的診斷關聯群 (DRGs )支付住院費用。DRG/PPS 的實施對不同特質醫院，因其服務功能落差大，所面臨之財務衝擊程度可能會有明顯不同，故藉此研究台灣DRG支付制度。
利用2004年全民健康保險資料庫，對台中縣市內醫院，採用健保局編審程式，進行DRG編輯，算出 DRG 落點及申請金額而加以分析。醫學中心病患之平均住院日數、醫療費用均高於其他層級醫院，因此，在實施DRGs制度之後，其能申報之醫療給付將大幅減少。
不同權屬別醫院在DRGs實施後，在健保給付雖然亦會受到影響，但其影響不似層級別顯著，權屬別會受影響，主要來自於所包括醫院層級結構不同所致。因此建議健保當局於實施DRGs制度，應考慮不同層級醫院在醫療照護的差異，及在現今的總額支付制度下實施DRGs對點值的影響等，擬訂相關的配套措施。

關鍵字

診斷關聯群、全民健康保險、支付制度

並列摘要

Reform of payment system is a common method used to increase medical efficiency, improve quality of care and contain medical cost in most countries. Since the implementation of National Health Insurance in Taiwan, on March 1st, 1995, there are frequent reforms in payment systems. Moreover, the Diagnosis Related Grouping (DRGs) payment，will be imposed on hospital care under the global budget system since January, 2008. On account of the big gap between service functions, there might have obvious differences facing to the degree of financial impact on different specialty hospitals after the implementation of DRG/PPS. From this point of view, we want to study the payment system of Taiwan.
Using the 2004 national health insurance databank, we adapt the National Health Insurance bureau processing-inspection formula to process the DRG,calculate the DRG dropping point, applied medical fees and analysis of all hospitals located on Taichung county and city.
The patients in medical centers have more average hospital days and medical fees than the other level hospitals, In other words, medical centers will be underpaid after the implementation of DRGs.After DRGs implement, the different ownership of hospital also influence by the National Health Insurance payment system. But the influence is less than the level of hospitals. The different ownership is influenced mainly comes from the different mix of hospital level. Therefore, we suggested the National Health Insurance authorities: Before the implement of DRGs, due to the cost gap exist in the different function of hospitals，they will face the different impact of DRGs on the point value under current system ,Bureau of National Health Insurance should be considered and worked out the relevant supplementary measures.

並列關鍵字

Diagnosis Related Groups，National Health Insurance ， Payment systems

參考文獻

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