居家護理服務成本分析－以某區域教學醫院為例

Cost Analysis of Home Health Nursing Service in a Regional Teaching Hospital

葉淑杏(Shu-Hsing Yeh) ； 陳淑娟(Shu-Chuan Chen) ； 吳秀麗(Hsiu-Li Wu) ； 林束棉(Shu-Nien Lin) ； 伍玉敏(Yu-Min Wu)

《長期照護雜誌》 9卷1期 (2005/03) Pp. 60-75

https://doi.org/10.6317/LTC.200503_9(1).0005

摘要

本研究係以區域教學醫院附設居家護理所收案之居家照護病患為調查對象，於2002年10月至12月間蒐集78個案例，探討居家護理病患結構、照護成本、損益分析及健保支付標準合理性，以提供保險機構修訂支付標準及醫院進行成本控管與發展居家照護服務之參考。研究結果顯示：案例以女性為主，平均年齡70歲，多為腦血管疾病，服務類別以RUGs第二類居多，收案性質以一般訪視為主，且多無醫師陪同訪視，照護模式多為居家訪視。成本結構中，人力成本(54%)及作業費用(36%)合計高達總成本90%。成本耗用雖不因不同資源耗用群組病人有所差異，但居家護理服務成本與健保支付標準兩者呈相當程度之相關。每人次訪視平均成本及盈餘分為l,300元及55元（利潤率為7%)，獲利偏低；機構訪視案例相較於居家訪視案例成本低獲利高；另醫師每人次訪視成本為l,334元，健保支付金額不足299元。建議：醫院方面宜建立居家照護標凖作業程序，進而合理有效的控制成本；積極擴展安養機構病患服務市場，集中護理師責任區域，降低每人次成本，以產生規模經濟利益。健保局方面宜審慎修訂醫師訪視費，並持續監測RUGs各群組耗用資源情形，以維持支付標準合理性，滿足民眾對長期照護之殷切需求。

關鍵字

居家護理 ； 成本分析 ； 資源耗用群

並列摘要

The study was to analyze the actual costs of home health nursing and the reasonability of reimbursement system from the resource utilization groups (RUGs) by the Bureau of National Health Insurance. Seventy-eight cases were collected on the patients of home health nursing from the regional teaching hospital affiliated home care center during October to December 2002. Cases analyses showed that the patients were mostly females, average 70 years old, and most of common diagnoses were cardiovascular accidents. The services provided were mainly in the 2nd class of RUGs. The character of cases was mainly general visits without doctor accompanying. In cost structure, the cost of personnel and operation was up to 90%. There were not significant differences among the RUGs2～RUGs4 costs, but significant correlation was found between home health nursing service and the reimbursement of NHI. Average cost and net profit of per home visit were NT$ 1,300 and NT$55, respectively. The average net profit was low. The institutional nursing visits have lower cost and higher profit than those of home health nursing services. Moreover, average cost of per doctor visit was NT$1,344, and there was a shortage of NT$299 under the reimbursement of NHI. The study suggests the hospital could establish the standard operation procedures of home health nursing to control reasonable costs, extending patients in the nursing homes and intermediate care facilities, concentrating the nurses duty areas, to reduce cost per home visit and increate economic scale advantages, In order to satisfy the long-term care needs of the people, the Bureau of National Health Insurance could consider if the reimbursements were reasonable to the RUGs and doctor visit by continually inspiring were used resources in the RUGs.

並列關鍵字

home health nursing service ； cost analysis ； RUGs