實施DRGs對醫院財務之影響－－以南部某區域醫院消化系統主診斷為例

Influence of DRGs on Hospital Finance of Inpatient Services: an Analysis on the Diseases of the Digestive System at a Regional Hospital in South Taiwan

台灣全民健康保險將於民國97年1月開始，實施住院診斷關聯群做為總額支付制度下重要的配套措施。本研究以南部某區域醫院之消化系統資料進行分析，以瞭解DRGs（diagnosis related groups payment system，診斷關聯群支付系統）實施後，定額給付對醫院住院醫療服務報酬之變化，以及對醫院財務之影響，並探討其影響因素。研究顯示：治療相同MDC（major diagnostic category，主要疾病類型）病人時，不同主治醫師的處置模式，在部份的MDC裡，會出現不同的財務風險。經單因子變異數分析檢定後，發現疾病DRG-15802及疾病DRG-18402的處置中，不同處置模式的主治醫師之間，差額/定額費用比率（ΔR/R）方面存有明顯的差異（p<0.05）；很明顯的，住院天數的長短是一項重要因子。其它的因素尚待後續的研究與分析。

The TNHI (Taiwan National Health Insurance) has been phasing in the Global Budget System step-by-step, and will soon launch the Diagnosis Related Groups payment system(DRGs) for inpatient services in the near future. In this study we utilized the TNHI claims data provided by a regional teaching hospital in the southern Taiwan, based on the medical information from digestive system diseases. To assess the financial risk, the hospitals running using the TNHI should be facing soon after the implementation of that DRGs, we intended to analyze those differences yield by various physician performances in the treatment of the same MDC(major diagnostic category) patients, for example: those variation in the treatment of the DRGs-15802 and DRGs-18402 (see Text) from different physician handling cases text, as well as the different influences on hospital management. Through this study, we could conclude that there are some financial risks that exist in certain MDC treatments, though not all, and that the duration of hospital days could be one of the major influencing factors for the financial risks.