全膝關節置換術於DRG制度下之醫療資源耗用分析-以某區域教學醫院為例

The Exploration of Medical Resources Utilization amoung Total Knee Replacement in DRGs-An example of a regional teaching hospital

周英豪(Chou ying-hao)

指導教授 ： 董和銳

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2011年)

摘要

背景與目的: 依據健保局公告資料，民國98年醫療費用核付金額4,436億元，相較於88年增加了67.4%；同時人口結構的老化也在持續，所以可以預期未來接受全人工膝關節置換術的人會持續增加，相對的政府在相關醫療資源的配當及支付制度上必須加以控管，所以本研究在分析中部某區域醫院DRG實施期間施行人工關節置換術所耗費的醫療資源後，以期能增加對醫療支出的了解及對品質的控管。
研究方法:利用中部某區域教學醫院民國98及99年全民健保費用申報檔案，以SPSS17.0軟體進行描述性統計、單因子變異數分析，並以迴歸分析影響醫療資源耗用之因素。
研究結果:總醫療費用、診療費、實際住院天數與性別有關，且男性高於女性；治療處置費、麻醉費則與年齡有關；另病房費、藥費則與術後是否感染有關。
結論與建議:近年來各醫療機構的醫療品質均因支付制度的變革而有所變化，在醫院經營的壓力下，如何避免捨重症而收治輕症患者的情形發生，除了調整健保支付制度外，亦需加強臨床人員的教育工作，以免病患的權益受到損害而肇生醫療糾紛事件。

關鍵字

DRG支付制度 ； 全膝關節置換 ； 醫療資源耗用

並列摘要

Background and goal: Based on the health insurance bureau announcement in 2009, the medical expenses pay the amount 443.6billion , increased 67.4% compared with 2008 . Simultaneously population structure's aging is also continuing, therefore it might anticipate that people who accept the Total knee replacement will increase in the future. So the government have to control the related medical resources and to distribute suitably. Therefore, this study analyzes a central regional hospital during the implementation of DRG in total knee replacement surgery after the cost of medical resources, with a view to increasing the understanding of medical expenses and quality control.
Research technique: The use of a regional teaching hospital in central Republican National Health Insurance 1998 and 1999 cost report files to SPSS17.0 software, descriptive statistics, single factor analysis of variance, and regression analysis of factors affecting consumption of medical resources.
The results: The total medical costs, medical fees, the actual length of stay and gender, and men than in women; treatment and disposal fees, anesthesia fees are age-related; other ward fees, medicines are and whether postoperative infection.
Conclusions and recommendations: In recent years, the quality of care of the medical institutions are due to changes in payment systems vary in the hospital under the pressure of business, how to avoid homes with severe and mild patients admitted to the scenarios, in addition to adjusting health care payment system, also need to strengthen the education of clinical staff, so as not to damage the interests of patients and health care disputes event.

並列關鍵字

The DRG payment system ； total knee replacement ； medical resources utilization

參考文獻

林碧珠、張蘇鈺、莊琴英(2000):人工關節置換術患者生活品質及其相關因素探討。護理研究，8(2):165-175。

陳婉茗、朱慧凡、錢慶文、蘇喜、吳肖琪(2006):醫院對即將全面實施DRGs支付制度之因應表現。醫務管理期刊，7(2):193-203。

盧瑞芬、謝啟瑞(2003):台灣醫院產業的市場結構與發展趨勢分析。經濟論文叢刊，31(1)：107-153。

李志偉、嚴嘉楓、羅慶徽、李宗楠、林金定(2005)。台灣地區智能障礙者的醫療利用特性與影響因素:以2001年門診利用分析。身心障礙研究，3(1)，5-17。

謝霖芬、陳文珊、莊志誠(2004):關節炎之復健。輔仁醫學期刊，2(1):17-42。