| 英文摘要 |
Bureau of National Health Insurance (BNHI) in Taiwan is planning to implement DRGs payment system in 2008. The impact of DRGs on medical cost-effectiveness has thus threatened hospital management accordingly. In this study we illustrated the experiences of physicians working for the department of general surgery in a hospital, and probed into those frequently-used 86 DRGs to examine whether (1) those high-cost outliers of DRGs should be excluded before analyses, (2) statistically significant differences in reimbursement of DRGs are presented between hospitals and across discharged cases, and (3) any managed approach could be developed for physicians to control medical fees of DRGs when patients still receive cares in a hospital. Data of inpatient reimbursement claims of 17 medical centers were acquired from BNHI in Taiwan in 2004. We collected discharged subjects complied with one of those 86 DRGs in terms of length of stay (LOS) less than 31 and being either MDC 6 or MDC 7. Four types of hospitals (i.e., public university, veterans general, private university and non-profit organizations) were analyzed in responding to differential item functioning (DIF) free. In compliance with the specified paid amount, upper and lower extreme payment of the individual DRGs released by BNHI, we categorized into two 2 thresholds for each DRG so as to examine whether data fit to the Rasch model’s requirement of unidimensionality and local independence. The results show that (1) Rasch analysis sufficiently discriminates DRGs outliers much more reasonably and stably than the traditional one, (2) there are 3 types of latent constructs delineating the behaviors of DRGs in general surgery, (3) DIFs are exhibited on several DRGs and some types of hospitals, and (4) a possible mechanism was proposed to physicians for managed controls on medical fees during patient. |
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