醫院權屬別對其論病例計酬醫療費用影響之研究—以剖腹生產為例

Hospital Ownership and Its Effect on Medical Costs from Case Payments Using Data from Cesarean Section Patients

林恆慶(Herng-Ching Lin) ； 楊長興(Chang-Hsing Yang) ； 陳楚杰(Chu-Chieh Chen) ； 黃昱瞳(Yu-Tung Huang)

《慈濟醫學雜誌》 15卷1期 (2003/02) Pp. 55-61

摘要

目的：本研究旨在以剖腹生產為例，探討醫院權屬別對其論病例計酬醫療費用之影響。材料與方法：使用由國家衛生研究院發行的2000年全民健康保險學術研究資料庫的次級資料，研究對象為2000年間在醫院進行剖腹生產的病人，以複迴歸分析法控制醫院層級、是否為教學醫院及病人之年齡等因素，以探討醫院權屬別與平均每位病人醫療費用間的相關性。結果：在控制醫院層級、是否為教學醫院及病人之年齡等因素後，發現醫院權屬別與接受剖腹生產病人的醫療費用間有顯著的相關性，私立醫院醫療費用比公立醫院和財團法人醫院的醫療費用低。結論：醫院醫療費用控制的能力因醫院權屬別而異，而導致私立醫院醫療費用比公立醫院和財團法人醫院的醫療費用低的可能原因為其醫院整體效率較高、實施臨床路徑、選擇較單純的病人及控制住院天數。

關鍵字

論病例計酬 ； 醫院權屬別 ； 醫療費用

並列摘要

Objective: The relationship between hospital ownership and charge per discharged cesarean section patient was studied. Materials and Methods: This study used the National Health Insurance Research Database of 2000. The subjects were patients undergoing a cesarean section from January 2000 to December 2000. Multiple regression was performed to explore the relationship between cost per discharge and hospital ownership after adjustment for accredited hospital level, whether a hospital was a teaching hospital, patient掇 age, and length of stay (LOS). Results: This study found that cost per discharge was significantly related to hospital ownership. This suggests that the costs for patients undergoing a cesarean section who were admitted to public hospitals were more likely to be higher than for those admitted to private hospitals. Conclusions: Hospital ownership is related to cost per discharge. Possible factors contributing to the relationship between hospital ownership and costs are hospital efficiency, the implementation of clinical pathways, patient dumping, and LOS.

並列關鍵字

case payment ； hospital ownership ； cost