降低調劑量超出導致健保折付方案

Improvement Program for the National Health Insurance Regressive Payment for Pharmacy Personnel

目的:健保實施後為了應付上漲的醫療費用,選擇改變給付制度(特別是總額)來控制。藥事人員部分,也於 2014 年 5 月 1 日公告實施「醫院藥事人員合理調 劑量」做每月結算,當實際調劑量超過合理調劑量,就會將超出案件的調劑費打對折,扣減 50% 給付,造成醫院損失。方法:(一)增聘藥師(二)掌握「工作人日數」計算原則(三)鼓勵優退、爭取新 人上線機會(四)爭取休假日來院上課,算上班時間。結果:2015 年被核扣的金額 1267088 元, 2016 年降為 799620 元,降幅為 36.9%。工作天數:由改善前的 22 天 / 月降低至改善後的 21 天 / 月。滿意度:由改 善前 2.6 分升至改善後至 4.9 分。結論:希望研究結果能夠給相關單位在人力資源管理時的參考,以提供藥師一個合理的工作環境。

 

Objective: Since the National Health Insurance (NHI) was established, the payment system have been changed several times, especially the global budget payment system, to reduce the high rising expenditure. The “regressive pharma-cist payment “ was announced on May 1, 2014, and the NHI calculates the payment according those rules. If the NHI finds pharmacist’s workload exceeds the rules, it will reduce the payment by 50%.Methods: We propose four methods: (1) Increasing the number of pharmacists, (2) understanding the rules for “Working Person’s Day”, (3) encouraging older pharmacists to retire and increase the number of post-graduated year pharma- cists, (4) making classes more relevant to work.Results: Detained money: In 2015, it was NT$1,267,088 . In 2016, it was NT$799,620, a decrease of 36.9%. The average working days decreased from 22 days/month to 21 days/month, and satisfaction increased from 2.6 points to 4.9 points.Conclusion: These results can help hospital authorities improve the working environment for pharmacists.