影響Tw-DRGs 4.0 敗血症醫療費用之因素-以某區域醫院為例

BThe influential factors of sepsis patients’ payment by Tw-DRGs 4.0.- A study in a regional hospital

中央健保署為持續支付改革，擬實施第三階段Tw-DRGs 4.0，本研究為因應其帶來之改變，將探討影響醫院敗血症醫療費用的重要因素。
本研究蒐集北部某區域醫院1,035名敗血症病患之住院醫療費用清單明細，採次級資料回溯研究進行統計分析。
結果顯示敗血症醫療費用在年齡分組、多重器官衰竭、出院死亡之雙變項檢定皆有顯著差異（p<0.001）。而線性複迴歸亦顯示在年齡（p<0.013）、多重器官衰竭、住院天數、出院死亡（p<0.001）等變項對醫療費用有顯著影響。
由於有二個以上器官衰竭診斷的敗血症病患，健保署已大幅提高其給付，故建議健保署導入新DRGs時，應審視疾病嚴重度，給予適當給付，以利往後新項目推行，亦建議醫師病歷書寫完整，疾分人員正確編碼，且醫院有效管控住院天數，以平衡品質和成本，永續經營。

In order to enhance payment reform, National Health Insurance (NHI) Administration has phased in the 3rd DRGs. This study aims at exploring the influential factors of sepsis patients’payments at a regional hospital by Tw-DRGs 4.0.
In this study we collected the information of 1,035 sepsis inpatients’medical expenses from a regional hospital in Northern Taiwan. This retrospective study was carried out using secondary data for its statistic analysis.
Results of Linear Multiple Regression indicated that age (p<0.013), multiple organ failure, length of hospital stay, and discharge by death (p<0.001) all had significant effects on medical expenses.
We found sepsis patients diagnosed with two or more organ failures were reimbursed with much higher NHI payments. Therefore, the NHI Administration should review the disease severity and reimburse more appropriate payments by introducing new DRGs. For achieving better sustainability, physicians should document the patient’s conditions in more detail, coders give correct DRGs, and hospitals better control the length of hospital stay and medical expenses in order to improve the balance between quality of care and permanent cost containment.