乳癌試辦計畫費用成效分析

An Analysis of Expense in the Breast Cancer Medical Plan

「早期正確診斷，早期正確治療」是治療癌症最好的作法，配合健保局 提出以「購買健康」為導向而推出的疾病醫療服務改善方案，可使醫療院所 回歸診療準則，朝向提供整體性的醫療照顧。本研究藉由資訊科技之特性， 針對健保局乳癌試辦計畫提出作業流程再造，將改善前後費用申報情形依治 療組合、醫師別、各病理分期的治療組合、病患別等四種申報費用與舊制 「論病歷計酬」的實際醫療費用比較其差額，來加以探討與分析。 申報費用比實際醫療費用少者，大多是有使用化學治療藥物的患者，且 集中在病理分期3 、4期以上有執行化學治療者，或病情複雜需多項組合治療 者，經驗證實施成效後，發現對醫院的財務虧損風險還是有合理的利潤空 間。研究之結果可提供給決策者作為擬定策略之參考，並擴大及建立各項腫 瘤個案管理制度與臨床拈引，使成為全人的、持續性的醫療照護措施。

Early Diagnosis correctly; early treatment precisely is the best method to cure cancer. The scheme regarding how to improve disease medical treatment service meets the guideline of purchasing healthy issued by the Bureau of National Health Insurance (BNHI), which can make hospitals back to the practice guidelines and forward the whole medical care. By means of information technology s Business Process Re-Engineering, this study offers the rebuilding work process concerning the plan of breast cancer made by the BNHI. Based on the expense application of cure combination, doctors, pathology stage combination, and patients, this study also analyzes and makes a comparison to real medical treatment balance between the new system and the Case Payment'. The results present most of the patients applying less medical treatment payment are the ones using chemotherapy, especially at the stage of three or four, or more complicated patients. Through this research, it finds that the hospitals still get reasonable profits under the financial risk. This study can provide some references and suggestions to those who make final decisions. It also extends and sets up better tumor case management and clinical protocols to reach the goal of well-built and continued measures of medical care.