| 摘要註: |
本研究主要以國內某地區醫院為對象,探討自民國99年1月1日實施疾病診斷關聯群健保支付制度前後各半年時間的個案醫院的服務量、生產力、品質指標、財務績效及病人滿意度各種數據分析差異、探討結果並評估績效。從而瞭解實施疾病診斷關聯群健保支付制度後,此一健保新制度對醫院、行政人員、醫師、護理人員及病人所產生的改變與影響。本研究採用個案研究方法,透過文獻蒐集及問卷調查,深入個案醫院內部根據各種數據分析及比較來獲得正確資訊。 研究結果顯示個案醫院全院及各科業績量、平均住院日、三日內再急診率、十四天再入院率、各科CMI值、以CMI校正之平均醫療費用皆沒有明顯差異,但在開刀人數有明顯地下降, 病歷診斷正確率有明顯提高,DRG155項的支付金額比實際醫療費用也有明顯地提高。實施疾病診斷關聯群健保支付制度半年後衝擊沒有預期大,主要DRG155項的前身論病例計酬支付制度已實施一段長時間而成效良好。建議醫院管理者必須要嚴格要求醫師做好入院時正確而有利的診斷編碼及正確的病歷寫作。降低醫院成本、病人住院天數及出院準備工作,來因應未來四年全面實施疾病診斷關聯群健保支付制度對醫院的衝擊。 This study aimed to compare the difference of selected community hospital on service volume, fecundity, quality indicator, financial performance, patients’ satisfaction between the first half of year 2000 and the second half of year 2000 when the Drug Related Groups (DRG) payment system came to effect. Further analyses were conduced in order to evaluate the hospital’s performance. With understanding of DRG payment system, we could try to anticipate how and what DRG payment system affects the hospital, healthcare staff, administrative staff, and patients. The adapted method in this study was case study. Through reviewing literature and questionnaire survey, more delicate data were collected for analysis.Our results indicated that the service volume of each department or the total service volume of the hospital, the average hospitalized day, 3-day ER revisit rate, 14-day rehospitalized day, CMI value of each department, and adjusted CMI value for average medical cost were not significant difference. However, the number of people receiving operation decreased dramatically. The accuracy of the case diagnosis rose obviously. The paid amount of DRG 155 items was higher than practical medical payment. Later half-year impact brought by implementation of DRG payment system was not as big as anticipated, the main reason was that the case payment, the former of DRG 155 items, has come to effect for a long time and the result has been far better. Herein we would like to suggest that hospital manager should strictly request physicians to use the correct diagnosis code and record chart accurately, those will bring the benefit for hospital to save the cost, reduce the hospitalized day, complete the preparation for discharge of patients. Those efforts will help to fully prepare hospitals to face the impact from overall implementation of DRG payment system in the upcoming four years. |