全民健保鼻中膈鼻道成形術論病例計酬制對醫療資源使用之影響

Imp acts of the Case Payment System for Septomeatoplasty on Medical Resource Utilization

宋霖霏(Lin-Fei Sung) ； 林昌誠(Chung-Chen Lin) ； 王泰隆(Tyrone Wang)

《北市醫學雜誌》 2卷5期 (2005/05) Pp. 465-474

https://doi.org/10.6200/TCMJ.2005.2.5.07

摘要

目的：鼻中膈鼻道成形術於1999年3月納入論病例計酬支付制度，本研究以此手術案例為樣本，探討論病例計酬支付制度的實施，對此手術醫療資源耗用情形的影響。方法：蒐集1997年3月至2001年3月間在臺北市立醫院耳鼻喉部住院接受鼻中膈鼻道成形術之手術病患，共計525筆資料。研究探討樣本之醫療資源使用情形在論病例計酬支付制度的實施前後的變化。以t-test、卡方檢定及ANOVA做統計分析。結果：論病例計酬制度的實施確實會影響市立醫院醫師的行為，總醫療費用於論病例計酬制度實施後顯著減少4.66%，住院日數於制度實施後平均減少約0.96日。結論：從醫療費用及住院日數資料反應醫療資源使用情形，論病例計酬制度的實施會減少醫療資源的耗用。

關鍵字

鼻中隔鼻道成形術 ； 論病例計酬制 ； 醫療資源

並列摘要

Background and Purpose: The implementation of the Case Payment System is aimed at controlling the continuously increasing healthcare expenditure in Taiwan. The objectives of this study were to investigate the impact of the Case Payment System on the practice of septomeatoplasty (SMP). Method: A total of 525 patients were enrolled, who had undergone septomeatoplasty at the Department of Otolaryngology in Taipei Municipal Hospitals during the period of March 1997 to March 2001. Medical resource utilization and healthcare costs were compared between groups of patients who were operated on before (170 patients) and after (355 patients) the implementation of the septomeatoplasty Case Payment System in March 1999. Analyses were conducted using t-test, chi-square and ANOVA. Results: We found that provider behaviors were influenced by the Case Payment System, and the average hospitalization was shortened by 0.96 days (p＜0.001). The total, up-front admission cost was reduced by 4.66%. Conclusion: The implementation of the Case Payment System proved to be effective in enhancing the efficiency of the practice of SMP, resulting in a small cost reduction.

並列關鍵字

septomeatoplasty ； case payment system ； medical resource utilization