實施臨床路徑對痔瘡切除手術醫療資源利用的影響

Eeffect of Clinigal Pathway on Medical Utilization of Hemorrhoidectomy

醫療費用的上漲已經成為全球性的問題，尤其是已實施國民健康保險的國家，更是積極尋求解決方案。我國在全民健康保險規劃時，部份住院病例的支付方式即已改採「論病例計酬制」，以取代原有的「論量計酬制」。醫療機構面臨此經營壓力，紛紛引進臨床路徑的概念及管理。本研究係針對論病例計酬制度對痔瘡切除手術醫療利用情形之影響，對醫療費用的持續效應進行描述性分析，並以南部某區域醫院於民國90年6月至92年11月連續30個月間，執行痔瘡切除手術案件為對象，針對醫療費用進行統計分析，結果顯示與醫療費用有關之處置費、麻醉費、特材費、藥費與總醫療費用均有顯著差異。本文亦就本研究之實務意涵，以及未來進一步研究課題加以說明。

The increment of the medical expenditure has been becoming a serious global problem. The countries currently carrying out national health insurance therefore, search for the solving way enthusiastically. In Taiwan, when national health insurance was initially planned, the case-payment system, instead of the fee-for-service system that was the prior one performed in the age of labors/public officers insurance, has been adopted to be the pay way for certain inpatients' diseases. In order to overcome the pressure from the newly developing case-payment system, that the medical industry is facing and is suffering from, most of the hospitals have been establishing the so-called clinical pathway for many, many a disease day by day. In this study, we intend to observe the effects of a clinical pathway for hemorrhoidectomy on the medical expenditure, and to discuss how it overcame the case-payment system, throughout the 30 months from June, 2001 to November, 2003, in a regional hospital in south Taiwan. We found there was a significant decrement in the general expense (i.e. medical expense in a whole), expense of pie-and post-surgery treatment/management, expense of anesthesia, expense of special materials and expense of medicament, with the performance of the clinical pathway. Besides, the duration of the hospital days was probably an important point to affect the general medical expenditure for the hemorrhoidectony, we noted.