全民健保住院診斷關聯群的實施對腹股溝疝氣手術醫療費用之影響

The Influence of Implementing Taiwan-Diagnosis Related Groups Treating Patients with Inguinal Hernia

本研究的目的在比較Tw-DRGs實施前後對腹股溝疝氣手術健保費用之影響。針對93-104年間（Tw-DRGs實施前93-98年，實施後99-104年）某區域醫院腹股溝疝氣手術2940個病人的住院健保申報資料進行分析。結果顯示Tw-DRGs的實施，住院日數顯著下降0.47天，縮短21.96%，可解釋的變異量為3.6%；醫令總數增加12.68個，增加32.35%，可解釋的變異量為42.5%；耗用點數雖增加1223.86點，增加4.82%，可解釋的變異量為4.1%，進一步分析費用類別則發現檢查及給藥等費用顯著減少；申報點數增加3162.98點，增加11.39%，可解釋的變異量為12.8%；申報與耗用差異增加1939.12點，增加80.61%，可解釋的變異量為5.0%，代表醫院額外獲得的利益增加。建議醫療院所可以依此模式分析不同Tw-DRGs碼在實施Tw-DRGs前後住院日數及醫療費用的狀況，以作為醫療院所因應Tw-DRGs實施之參考。

The purpose of this study was to investigate the influence of implementing Tw-DRGs (Taiwan- Diagnosis Related Groups) treating patients with inguinal hernia. The 2940 inpatients data in a regional hospital was from 2004 to 2015 year (pre-Tw-DRGs: 2004 to 2009 year, post- Tw-DRGs: 2010 to 2015 year). The results showed that the implementation of Tw-DRGs, significantly reduced length of stay 0.47 days, shortening 21.96%, in which it accounted for 4.7% of the variance. The total number of medical orders increased 12.68, increasing 32.35%, the amount of variability can be explained 42.5%. Consumption points increased by 1223.86 points, an increase of 4.82%, the variability of 4.1% can be explained, and further analysis found that the laboratory and medication fees significantly reduced. The points of declaration and the difference between declaration and consumption increased by 3162.98 and 1939.12 points, an increase of 11.39% and 80.61%, and the explanatory variance was 12.8% and 5.0%. The result of our study will help for further implementing DRGs and the reaction of hospital for DRGs.