診斷關聯群組前瞻性支付制度對於台灣醫療機構獲利能力之影響

Impact of the Diagnosis Related Groups Prospective Payment System on the Profitability of Hospitals in Taiwan

目的：本研究探討診斷關聯群組前瞻性支付制度（DRGs）對於台灣的醫學中心及區域醫院之獲利能力所產生的影響。方法：本研究採用營業利益率作為醫院獲利能力的主要指標，結合另外六項財務指標，透過2008年至2011年間經查核之財務報表進行各醫療院所獲利能力之評估。本研究使用相關性分析法探討各財務指標之間的關聯性，並且以成對T檢定法評估DRGs制度對於醫療機構獲利能力產生的影響。本研究並比較醫學中心及區域醫院在財務績效上的差異性。結果：相關性分析法顯示住院收入對其醫療收入淨額之比率與獲利能力呈現負相關。DRGs制度自2010年實施以後，醫院的平均營業利益率降低1.57%而住院收入、醫療收入淨額以及醫療成本分別上升11.58%、12.84%以及14.64%。本研究也發現住院收入對醫療成本之比例下降3 .59%。進行層級別醫院之比較分析顯示在實施DRGs制度以後，醫學中心的財務績效落後於區域醫院。結論：實施DRGs制度，目前並未顯著減少台灣醫療機構的醫療收入，且未影響其獲利能力。

Objectives. The aim of this study was to investigate the financial impact on profitability of the Diagnosis Related Groups(DRGs) system of health care reimbursement on medical centers and regional hospitals in Taiwan. Methods. This study used operating profit margin as the primary indicator of hospital profitability, along with six other financial indicators in audited annual financial statements from the years 2008 to 2011, to analyze the profitability and financial performance of hospitals. Correlations analysis was performed to clarify the relationship between each indicator, while post DRGs changes in profitability were evaluated by paired-sample t-test. This study also compared the differences in financial performance between medical centers and regional hospitals. Results. Correlation analysis found the proportion of inpatient revenues to net operating revenues of a hospital to be negatively correlated with profit margins. After the introduction of DRGs in 2010, the average operating profit margin decreased by 1.57%, while inpatient revenues, net operating revenues and operating expenses increased by 11.58%, 12.84% and 14.64%, respectively. Inpatient revenues as a proportion of operating expenses declined by an average of3.59%. Data was then grouped by hospital level for analysis, which revealed that medical centers performed worse than their regional counterparts after DRGs implementation. Conclusion. Implementation of the DRGs prospective payment system at current stage did not appear to significantly curb revenues or alter profitability of hospitals in Taiwan.