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  • 學位論文

精神分裂症醫療給付改善方案之評估-以中部某精神醫院為例

The Evaluation of Pay-for-Performance Programs for Schizophrenia in Taiwan Mental Hospital

指導教授 : 龔佩珍
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摘要


目的:依據行政院衛生署統計,2007至2009年台灣地區精神病患門診就診人數由1,990,917人成長至2,146,224人。衛生署為提升醫療照護品質,於2001年11月陸續推出「論質計酬方案」,至2010年更推出「精神分裂症醫療給付改善方案」,試將醫療給付與醫療品質結合,本研究以中部某精神專科醫院為例,探討「精神分裂症醫療給付改善方案」之成效及精神病門診醫療利用之影響因素。 方法:研究對象為中部某精神專科醫院2010年加入「給付改善方案」之門、住診病患共1,633人,並串聯其2009至2010年門、住診醫療費用申報檔,以SPSS 12.0軟體進行資料分析,統計方法除敘述性統計外,並以成對樣本T檢定、McNemar檢定分析品質指標,最後以線性複迴歸模式,分析醫療給付改善方案實施後,影響精神分裂症門診醫療利用之相關因素。 結果:精神分裂病患男性略多於女性;年齡以40歲至60歲居多;教育程度以國、高中為主。品質指標部份:精神科急性病房平均住院天數及住院人次比率皆增加,但慢性病房平均住院天數及住院人次皆下降。由研究之迴歸模型顯示:改善方案介入後,教育程度越高,門診醫療利用差異增加越多;本研究認為給付改善方案對於教育程度較高者,介入成效較佳。另一方面,隨著病史的增加,門診醫療利用次數差異卻減少。 建議:由於目前品質指標中尚有部分指標未能達到評量標準,建議持續推動此醫療給付改善方案,並向醫療院所詳盡宣導醫療給付改善方案之相關細節,鼓勵醫療院所積極參與並加入給付改善方案,希望藉由醫療提供者執行完善的個案管理,主動追蹤病患就醫情形,有效提升精神病患整體醫療服務品質。

並列摘要


Objective: According to Department of Health of Executive Yuan, the number of psychiatric outpatients in Taiwan had increased from 1,990,917 to 2,146,224 between 2007 and 2009. To improve medical care quality, the Department of Health launched a series of Pay-for-Performance programs. In 2010, the department also implemented the Schizophrenia Medical Care Benefits Improvement Program to joint medical benefits to medical quality. This study took a psychiatric special hospital at central Taiwan as an example to analyze the leverage of the Schizophrenia Medical Care Benefits Improvement Program and factors affecting psychiatric clinics’ medical utilization. Methods: The study subjects were 1,633 outpatients and inpatients of a hospital at central Taiwan, and they had joined the medical benefits improvement programs in 2010. The authors analyzed the study subjects’ 2009 – 2010 medical claims for clinical visits and hospital admission using SPSS 12.0. Besides conducting descriptive statistics, the author also carried out the paired t-test, the McNemar’s test for analyzing quality indicators, and linear regression analysis for examining factors affecting the psychiatric clinic’s medical utilization after the implementation of the medical benefits improvement program. Results: There were more male subjects than female ones in this study, and the majority of the subjects were 40 – 60 years old with junior high or high school education. For the quality indicators, the average length of hospital stay and the number of inpatients both increased in the psychiatric emergency ward but decreased in the chronic ward. Results from the regression analysis suggest that after introducing the improvement program, there was an increased variation in the clinic’s medical utilization of patients with higher education. The authors consider that this benefits improvement program intervention is more effective for patients with higher education. It was also found from this study that medical utilization frequency of this psychiatric clinic varied less with longer medical history. Suggestions: Presently, there are still some quality indicators that do not meet the evaluation criteria. The government should work on promoting the medical benefits improvement program, to disseminate more detailed information related to the medical benefits improvement program to hospitals and clinics, and to encourage hospitals and clinics to proactively participate in the medical benefits improvement program. If our medical providers can implement sturdy case management and keep track of patients’ medical conditions proactively, then the overall medical service quality for psychiatric patients will be elevated effectively.

參考文獻


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被引用紀錄


張瓊媖(2012)。「精神分裂症個案管理計畫」之門診病患就醫行為與費用探討-以某區域教學醫院為例〔碩士論文,元智大學〕。華藝線上圖書館。https://doi.org/10.6838%2fYZU.2012.00099

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