實施品質獎勵金下醫師選擇個案之影響－以糖尿病為例

Tunghai University Institutional Repository > 工學院 > 工業工程與經營資訊學系所 > 碩博士論文 > Item 310901/2113

Please use this identifier to cite or link to this item: http://140.128.103.80:8080/handle/310901/2113

Title:	實施品質獎勵金下醫師選擇個案之影響－以糖尿病為例
Other Titles:	Effects of Doctors’ Selection of Patients Under Quality Incentives －A case Study of Diabetes Payments
Authors:	王暄晴 Wang, Hsuan-Ching
Contributors:	張炳騰 Chang, Peng-Teng 東海大學工業工程與經營資訊學系
Keywords:	糖尿病;論質計酬;品質獎勵金;選擇病人;結構方程式 Diabetes;Pay-by-quality;patient selection;Structural equation modeling
Date:	2008
Issue Date:	2011-03-09T07:31:40Z (UTC)
Abstract:	本研究主要是以健保局主導的「糖尿病醫療給付改善方案」為例，來評估品質獎勵臨床指標對醫療提供者選擇新收案病人之影響；並闡示品質獎勵金、醫療機構、醫師特性對選擇新收病人臨床指標之影響，以供決策主管機關未來規劃及修訂方案之參考。以中央健康保險局中區分局2006 年（N=12631）至2007 年（N=11627），有參與「糖尿病醫療給付改善方案」之醫療機構、醫師且在健保局糖尿病網頁「糖尿病照護診療資料檔」登錄之新收案病人皆列為研究對象。利用EXCEL For Windows 及LISREL8.80版統計套裝軟體，進行所有資料內容的描述性及推論性統計，且利用結構方程模式（SEM）探討醫療機構屬性、醫師特性與新收案病人臨床指標的路徑關係。本研究主要發現：一、本研究結果顯示品質獎勵金實施後，依不同定義之照護率分析皆呈現負成長現象，醫院總額實施前後差異值為0.36％~0.62％、基層總額實施前後差異值為0.34％~0.46％。二、醫療機構會依據品質獎勵指標（HbA1C、LDL）選擇新收案病人，關係係數的變化為醣化血色素由實施前（-0.18）變成實施後（0.01）、低密度脂蛋白由實施前（-0.05）變成實施後（0.00）。三、醫療機構屬性與病人臨床指標路徑關係上，實施品質獎勵金前後確亦產生差異。對健保局等決策機關而言，醫療支付政策所可能產生的連鎖效應須特別關注與檢討，使醫療資源配置不致扭曲，而能朝正向發展。建議未來決策主管機關應當思考如何將更多品質獎勵指標納入類似研究，確保推動論質計酬獎勵指標更具實證基礎，俾利給付方式更具公平性與說服力；並定期監控品質獎勵金對醫療機構產生選擇病人的效應，以維護病人接受照護的基本權益。 In order to correct medical behaviors and improve the efficiency of diabetes care health service, the Taiwan Bureau of National Health Insurance (BNHI) has introduced the disease management since 2001. Until 2007,to strength the clinical outcome, the Bureau of NationalHealth Insurance (BNHI) introduced a pay for performance.In Taiwan, there has been no study about patient selection for specific disease yet. we need more studies to understand the patient selection of hospital behaviors . Therefore, the objectives of this study are to evaluate effects of Doctors’ selection of patients under quality incentives, to analyze factors influencing patient selection.The study applied “before-after comparison design” for secondary data analysis based on claim data and web-site patient registry data provided by BNHI (2006,2007). Patients who have registry data in 2006 will be considered as control group. We analyzed the data byStructural Equation Modeling (SEM,for path analysis).The results showed that there were quality incentives implementation, hospital characteristics, and doctor characteristics all significantly related to patient selection.In 2006, patient’s clinical indicators were age, HbA1C, LDL.In 2007, patient’s clinical indicators were SBP, EBP, HbA1C, LDL and TG.
Appears in Collections:	[工業工程與經營資訊學系所] 碩博士論文

Files in This Item:

File	Size	Format
index.html	0Kb	HTML	353	View/Open

Loading...