分析全民健保資料庫以評估鼻中膈鼻道成型手術論病例計酬制實施之影響

The Impacts of Case Payment System on the Practice of Septomeatoplastry--National Healthcare Insurance Database Analysis

本研究利用全民健保資料庫探討「論病例計酬制度」的實施對成人鼻中 隔鼻道成形術（ Septomeatoplast句， SMP） 的影響。研究對象為1998 年至2000 年接受鼻中隔鼻道成形術手術之病患，共6.046 例。1999 年3 月實施鼻中隔鼻 道成形術論病例計酬制後，研究進行「論量計酬」（2 ，1 01 人）及「論病例計酬」 （3 ， 945 人）兩種不同支付制度下病患特質、醫療費用、醫療資源耗用以及醫療 品質四大層面影響的差異探討。研究結果顯示樣本平均年齡33.7 士14.8 歲， 「論病例計酬」實施後病人有向醫學中心流動的傾向，有其他系統合併症也減 少，但較無臨床上意義；醫療資源耗用方面，論病例計酬組其平均住院天數 比論量計酬組顯著地減少0.6 天（p

Using National Healthcare Insurance Database, we investigate the impacts of case payment system on adult septomeatoplasty (SMP). A total of 6,046 patients who underwent SMP during the period from 1998 to 2000 were identified (fee for service - FFS, 2,101 patients; case payment system - CPS, 3,945 patients). Four aspects of impacts, including patient selection, medical resource utilization, healthcare expenses and quality were compared between FFS and CPS groups following the implementation of SMP case payment system on March 1 1999. Our analyses results shows the mean age of patients was 33.7 14.8 years-old. There was a significant trend of increased SMP utilization in medical center after implementation of CPS; the incidence of systemic comorbidities were also reduced, but may not be meaningful clinically. The average length of stay (LOS) was significantly shortened by 0.6 day (p<0.001). The total claimed amount remained unchanged (p>0.05) because that the average LOS was shortened by less than 1 day. There was no change in quality of care in both FFS and CPS groups. The implementation of CPS proved to be effective to enhance efficiency by reducing LOS. We find systemic comorbidities, provider service volume, payment system, are significant confounders of healthcare quality.