法學期刊
論著名稱: Tw-DRGs 制度下醫院費用損益與住院日數相關性探討-以某地區教學醫院為例
編著譯者: 李培芬
出版日期: 2018.01
刊登出處: 台灣/醫療品質雜誌第 12 卷 第 1 期 /58-67 頁
頁  數: 10 點閱次數: 376
下載點數: 40 點 銷售明細: 權利金查詢 變更售價
授 權 者: 財團法人醫院評鑑暨醫療品質策進會 授權者指定不分配權利金給作者)
關 鍵 詞: 臺灣版全民健保住院診斷關聯群主要疾病類別落點損益率超期率
中文摘要: 目的:Tw-DRGs 個案損益率及超期率之相關研究,探討醫院因應支付制度改變之策略。
材料及方法:以個案醫院健保申報資料,申報明細與 Tw-DRG 分類表串檔,分析 MDC 別、Tw-DRGs 別、落點、損益率、超期率相關性。
結果:MDC8 個、18 個科別、Tw-DRGs154 個;16.1% 落點在虧損區佔率不高,多數落在溢酬區。69.6% 小於等於幾何平均住院日數佔多數。無論在 4 個落點或 8 個 MDC 間,損益率與超期率皆有顯著差異。各 Tw-DRG 超期率與損益率 75% 有顯著相關性。Pearson 分析超期率與損益率二者之間具有顯著相關性。
結論:損益率越低者超期率越高。損益結果與檢查、處置碼等因素亦十分相關。住院診療品質並未因醫療資源耗用少或住院日數縮短而降低。縮短住院日數會相對提高病床利用率,不論是否能得到溢酬,皆有助於醫療資源的有效利用,轉而提升醫療照護品質。
英文關鍵詞: Taiwan diagnosis-related groupsmajor disease categoriesplacementprofit and loss rateoverdue rate
英文摘要: Objective: To study the relationship between the profit and loss rate and the overdue rate of Taiwan diagnosis related groups (Tw-DRGs) cases and to explore strategies for changing the hospital’s payment system.
Materials and Methods: Based on hospital health insurance data and the Tw-DRG classification table, the correlations between major disease categories(MDCs) and other Tw-DRGs, location, profit and loss rate, and overdue rate were analyzed.
Result: Eight MDCs, 18 patients, 154 Tw-DRGs; 16.1% in the loss zone, mostly in the premium area. 69.6% less than or equal to the geometric average number of hospitalizations accounted for the majority. In 4 locations and 8 MDCs, profit and loss rates and overdue rates were significantly different. Tw-DRG overtime rate and profit and loss rate were significantly correlated. There was a significant correlation between the overdue and profit and loss rates in Pearson analysis.
Conclusion: Lower profit and loss rates are associated with a higher overdue rate. Inspection, procedure code, and other factors are also related to profit and loss. The quality of hospitalization did not decrease due to fewer medical resources or shorter hospitalization. Shortening hospitalization will improve the availability of hospital beds, regardless of whether premiums are available, and contribute to the effective use of medical resources, thus enhancing the quality of medical care.
目  次: 前言
研究目的
文獻探討
研究材料與方法
一、研究材料
二、研究方法
研究結果
一、描述性統計
二、超期率與損益率在不同落點之分析
三、不同 MDC、Tw-DRG 之間損益率與超期率之分析
四、各 Tw-DRG 超期率與損益率之分析
五、住院診療品質指標
結論與建議
研究限制
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