Inappropriate Hospital Utilization for Long-stay Patients in Southern Taiwan

本研究旨在評估全民健保體制下，住院病患不合理的醫療服務利用情形。長期住院病患樣本來自於台灣部地區不同層級之醫院。研究樣本為南部地區急性醫院住院長達30天以上之長期病患，其資料蒐集醫院包括南台灣4家醫學中心、6家區域醫院和21家地區醫院。研究期間為1996年1月及同年5月，研究工具為研究團隊所發展之－急性醫院長期住院病患問卷，除去遺漏值及非常態之住院之病患，340位（63.4%）病患則為合理的住院。依醫院層級分別瞭解不合理留院比例，醫學中心為32.2%、區域醫院為45.4%、地區醫院為43.3%；與醫學中心相比，區域及地區醫院之不合理留院比例較高，且達統計顯著差異水準。本研究證實醫療院所的確存在著不合理的住院日數，此原因可能源於病人特質、醫療院所本身或是全民健康保險的支付制度所導致，健保局若能就不需急性醫療照護但仍需次級醫療照護之病患提供適當之給付，將改變病患救醫療行為和促使醫院修正出院計畫而增加病床有效應用。

關鍵字

適當性；醫院服務利用；長期住院病人；台灣

並列摘要

This study examined the inappropriate utilization of hospital services under the National Health Insurance (NHI) program. The study population consisted of long-stay inpatients who stayed longer than 30 days in acute care hospitals located in southern Taiwan. The study hospitals included four medical centers, six regional hospitals, and 21 district general hospitals. The survey of patients was conducted in January and May of 1996 using the Acute Care Hospital Long-stay Questionnaire developed by the research team. Excluding subjects with missing values and abnormal length of stay, 536 long-stay patients were included in the analysis. Among these, 196 patients (36.6%) were classified as having an inappropriate stay, while 340 patients (63.4%) had an appropriate stay. Of the long-stay patients in medical centers, 32.2% were inappropriate stays; this figure was 45.4% for regional hospitals and 43.3% for district general hospitals. There were significantly higher proportions of inappropriate long-stay patients in regional and district general hospitals than in medical centers. In conclusion, this study confirms the existence of inappropriate hospital bed days, which may be due to patient characteristics, hospital factors, and NHI payment schemes. If the NHI program can provide incentives to long-stay patients who no longer need acute care to move, patients’ utilization behaviors might change and hospital discharge plans could Be modified for more efficient utilization of hospital beds.

並列關鍵字

appropriateness ； hospital utilization ； long-stay patients ； Taiwan

國際替代計量

Inappropriate Hospital Utilization for Long-stay Patients in Southern Taiwan

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