探討疾病嚴重度對Tw-DRGs醫療費用解釋力的影響─以呼吸系統之疾病與疾患為例

林學謙

doi:10.6833/CJCU.2011.00074

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探討疾病嚴重度對Tw-DRGs醫療費用解釋力的影響─以呼吸系統之疾病與疾患為例

The Effect of Severity on the Explanation of Tw-DRGs Medical Expenditures– An Example of Diseases and Disorders of the Respiratory System.

林學謙 , Masters　　Advisor：黃偉堯　　

繁體中文 DOI： 10.6833/CJCU.2011.00074

診斷關聯群；疾病嚴重度；呼吸系統之疾病與疾患；醫療費用； Diagnosis Related Groups ； Severity ； Diseases and Disorders of the Respiratory System ； Medical Expenditures

Abstract │ Reference (55) │ Times Cited (1) │ Altmetrics

Abstract 〈TOP〉

Parallel Abstract 〈TOP〉

Background：In order to control the rising medical expenditures, the Taiwan Diagnosis Related Groups (Tw-DRGs) was implemented since 2010 to pay for hospitalization expenses, creating financial inducements to encourage healthcare service providers to improve efficiency and to reduce costs. Diseases severity is an important classifying factor in the DRGs classification system, and the explanation of medical expenditures is still having improvable space.

Objective： This study aims to use the classification of severity of MS-DRGs to replace the classification of severity of Tw-DRGs version 3.0, so as to simulate the explanation of medical expenditures.

Design： This study is a cross-sectional, simulated study. Secondary data was collected from the National Health Insurance Research Database in 2008, including two groups of claims data: Registry for Contracted Medical Facilities and Inpatient Expenditures by Admissions. Patients with respiratory diseases and disorders in the Major Diagnosis Category 4 (MDC4) of Tw-DRGs version 3.0 were categorized  based on the severity classification systems of Tw-DRGs version 3.0 and of MS-DRGs respectively. This study calculated and compared the explanation of medical expenditures and the related weights (RW) of the two aforementioned severity classification systems. Furthermore, this study eliminated the outliers of medical expenses, and analyzed again the explanation of medical expenditures.

Results： When classifying patients in the Major Diagnosis Category 4 of Tw-DRGs version 3.0 using the severity classification systems in Tw-DRGs version 3.0, the explanation of medical expenditures was 0.4566. Meanwhile, adopting the severity classification system of MS-DRGs resulted in an explanation of medical expenditures of 0.4759, with an increase of 4.23%. After trimming the outliers of medical expenses, the explanation of medical expenditures when adopting the severity classification system of Tw-DRGs version 3.0 was 0.5177 whereas the explanation of medical expenditures was 0.5334 when adopting the MS-DRGs severity classification system, with an increase of 3.03%. Moreover, 43 BaseDRGs altered the severity classification system, 38 RW of BaseDRGs increased deviations; After trimming the outliers of medical expenses, 39 RW of BaseDRGs increased deviations, the result showed a more centralized classification of patients with similar resource consumptions as.

Conclusion： The alteration of severity classification systems had impact on the explanation of hospitalization expenses of Tw-DRGs version 3.0. In terms of patients in the Major Diagnosis Category 4 of the Tw-DRGs version 3.0, the change from the two-level classification system of Tw-DRGs version 3.0 to the three-level MS-DRGs system has improved the explanation of medical expenditures.

Reference ( 55 ) 〈TOP〉

Charlson, M., Pompei, P., Ales, K., & Mackenzie, C. (1987). A New Method of classifying prognostic comorbidity in longitudinal studies: Development and Validation. J Chron Dis, 40(5), 373-383.
連結：
David, C. H., Cathaleen, A. A., Brian, P. R., Linda, M. M., & Mark, K. W. (1992). Medicare Reimbursement Accuracy Under the Prospective Payment System, 1985 to 1988. Journal of the American Medical Association, 268(7), 896-899.
連結：
Ellis, R. P., & McGuire, T. C. (1993). Supply-side and demand-side cost sharing in health care. Journal of Economic Perspectives, 7(4), 135-51.
連結：
Engström, S. G., Carlsson, L., Ostgren, C. J., Nilsson, G. H., & Borgquist, L. A. (2006). The importance of comorbidity in analysing patient costs in Swedish primary care. BMC Public Health, 6(36), 1-7.
連結：
Freeman, J. L., Fetter, R. B., Park, H., Schneider, K. C., Lichtenstein, J. L., & Hughes, J. S., et al. (1995). Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications. Medical Care, 33, 806-27.
連結：

Times Cited (1) 〈TOP〉

陳偉哲(2016)。Tw-DRGs支付制度對於醫療資源耗用之影響探討- 以南部某區域教學醫院 DRG 23402為例。義守大學醫務管理學系學位論文。2016。1-80。

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