| Abstract: | 本研究的目的為探討「呼吸器依賴患者整合性照護前瞻性支付試辦計畫」實施六年後，醫療資源使用之情形是否與試辦計畫實施前有任何差異。研究結果顯示：雖整體之醫療資源耗用於2007年有顯著性降低，每人次醫療費用由800136.32元下降至327774.18元，每人次住院天數由57.25天下降至30.08天(醫療費P值=0.01，住院天數P值=0.02)。但由各分局、各權屬別、各就診科別及年齡別分析，發現僅有少部分具有顯著性差異。在醫療費用項目中，分局別無顯著性差異，在權屬別、就診科別及年齡別中，皆有部份達顯著性差異。於權屬別中是權屬別4「公立醫學院校附設醫院」、權屬別13「私立醫學院校附設醫院」，P值分別為0.019、0.037；於就診科別中代號1即就診「胸腔內科」病患也達顯著差異，其P值為0.043；於年齡別中是代號3即「60~80歲」有顯著差異，其P值為0.008。在住院天數項目中，分局別、權屬別及就診科別均顯示無顯著性差異，在年齡別，有部份達顯著性差異。於年齡別中代號3即「60~80歲」有顯著差異，其P值為0.034。值得注意的是該年齡別之族群中其醫療費用及住院天數皆有顯著性下降情形。
Since 2000, a “Ventilator Dependent Patients Integrated Delivery System” has been initiated by National Health Insurance. However, whether the system can improve the improper situations of using medical resources is an issue and requires a study. By studying the claim data (years 2000 and 2007) in National Health Insurance Research Database, the following results were found. Although the overall consumption of medical resources is decrease significantly in 2007, medical costs per person dropped from the NTD 800,136.32 to NTD 327,774.18, hospitalized days per person fell to 30.08 days from the 57.25 days (medical cost P = 0.01, hospital days P = 0.02), the improvement does not reach to all of the patients when comparing the cases stratifying by the NHI regions, hospital category, the medical treatment department and age-specific analysis in both years. When comparing in NHI regions before and after integration plans, results in medical costs show no significant improvement. While in hospital category, the medical treatment department and age-specific, there are some significant differences. When stratifying by the hospital Category, cases in No. 04 "Hospital public medical schools" and No. 13 "Hospital private medical schools", P values respectively were 0.019, 0.037. When stratifying by the medical treatment department, patients have significant differences in No. 1 "Chest medicine" (P = 0.043). In age-specific, patients in No. 3 "60 to 80 years old" are significantly different (P = 0.008). In hospitalized days, only patients in age-specific No. 3 "60 to 80 years old" are significantly different (P=0.034). It is worth noting that in age-specific No. 3 in its medical cost and hospitalization days have a significant drop when comparing cases in both years. |
