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鼻中膈鼻道成形術論病例計酬制實施之影響評估

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鼻中膈鼻道成形術論病例計酬制實施之影響評估

戴志展;王拔群;宋霖霏;郭乃文;蔡銘修;曾憲彰

Abstract

背景為應付醫療費用不斷上漲的問題,保險人常改變支付制度來控制醫療資源的支出,實施論病 例計酬支付制度的實施是其中一種方式。鼻中膈鼻道成形術 (Septomeatoplastry,SMP)於 民國88 年 3 月納入論病例計酬支付制度,本研究係以此手術案例為樣本,探討論病例計酬支付 制度的實施,對SMP手術執行各種層面的影響。 方法收集研究對象為民國 87 年 7 月至民國 88 年10 月間在某一醫學中心耳鼻喉科住院接受SMP手術之病患,共計收入 314 筆資料,其中病 例計酬支付制度,實施前共129 位,實施後共 185 位。研究探討支付制度的實施前後手術結果、 病患滿意度、醫療資源耗用情形、醫療費用的變化。以t test及卡方檢定(chi-square test)做 統計分析。 結果論病例計酬支付制度實施前後,手術成功率、併發症發生比例及病患滿意度均 未達統計上的顯著差異,顯示支付制度改變對手術的預後並無顯著地影響。醫療資源的耗用情形 在用藥部分,口服藥品使用量增加取代注射用藥,而住院天數平均縮短 0.3 天,達統計上的顯 著差異(p < 0.05) ,支付制度確能改變醫師行為。而總醫療費用顯著地減少 12.1 %。結論論 病歷計酬制度實施,確能小幅度增進SMP手術成本的控制,其反應於總醫療費用上顯著地降低。 而醫療資源耗用增減的變化,顯示支付制度確能改變醫師行為。然從手術後的併發症、手術成功 率、病患滿意度的資料來探討醫療品質,由於基本診療項目規定過份僵化,醫療提供者無法彈性 運用服務資源,在此資源極度侷限的情況下,醫療品質維護已達醫療提供者最大極限。

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