臺灣醫界對Tw-DRGs制度的反省：從實證角度出發——以心臟外科為例【本期企劃】   全文下載

Evidence-based reflection on diagnosis-related group payment method

Tw-DRGs自2010年開始實施第一及第二階段以來，基於實證資料，本文建議：一、以心臟血管外科手術為例，區域醫院手術數目增幅反而高過醫學中心，原因可能是Tw-DRGs支付方式以全國為計算基礎，對成本較高的醫學中心不利。故而，基本診療加成率應對醫學中心增加，以反映醫學中心之成本。二、重症醫療專科的Tw-DRGs正價差率遠低於醫學中心或全國的價差率。從而CMI加成不僅不應刪除，反而要提升重症醫療專科的Tw-DRGs之CMI加成幅度，方有助於避免「五大皆空」惡化，也有效降低實施第三階段Tw-DRGs的阻力；但不應全院加成。三、高價醫材與高價藥物是實施第三階段Tw-DRGs的最大阻力。有健保給付之高價醫材與高價藥物應採外加方式，核實申報。

Tw-DRGs were launched since 2010. Some evidence-based studies were showed as followed.

1.The increasing operation number of cardiovascular surgeries of regional hospitals is more than those of medical centers.

2.Using whole Taiwan medical expenditure as the basis of DRG payment method, it is unfair to the medical centers.

3.Some DRG of the critical care disciplines need more support financially. The case mixed index should be maintained on these DRG.

4.High priced medical products and drugs are big problems for the further development of Tw-DRGs.

According to these studies, we suggested,

1.The DRG payment of the medial centers should be higher than those of the regional hospitals.

2.Case mixed index of the DRG of the critical care disciplines should be maintained and adjusted even higher.

3.High priced medical products and drugs should be removed from the DRG payment method and be reimbursed for actual expenses.