總額支付制度下個別醫院醫療費用預測模型建立──以某教學醫院為例

Healthcare Expenditure Forecast Model for a Global Budget System - A Case Study in a Teaching Hospital

目的：建構個案醫院全民健康保險住院醫療費用變動時間序列預測模式，期能在健保局實施之管控措施下，亦能有效控制醫療費用及預測醫療費用成長及洽定個別醫院較佳之醫療費用預算。材料與方法： 分析個案醫院2002年7月至2007年6月全民健康保險住院醫療費用、醫師人數及病床數資料。結果：整體模型以住院人次、住院天數及平均住院天數對當期醫療費用的成長有顯著的成長，達到p<0.05顯著水準。結論： 以時間序列預測模式個別醫院住院醫療費用成長趨勢，可促使個別醫院與健保局協議前能預測己身醫療費用成長情形，以洽定較佳之醫療費用目標點數。

Objective: This purpose of this study is to establish an Auto-regressive Integrated Moving Average Model for hospitals to use to control and predict the growth of inpatient healthcare expenditures in a global budget system. With the forecast model, the individual hospital can have a better understanding of its target budget during negotiations with the Bureau of National Health Insurance. Material and Methods: Data on inpatient healthcare expenditures, number of physicians, and sick beds were collected from July 2002 to June 2007 for the case hospital.[By “sick beds” do you mean “occupied beds” or “number of patients”. If this is for a western audience, occupied beds or number of patients requiring care would be more understandable.] Results: Implementing the model for inpatient hospital days, length of stay and average length of stay achieved significant results for each (P<0.05). Conclusion: The individual hospital can use the time-series model to predict the growth trends of inpatient healthcare expenditures before negotiating the target budget with the Bureau of National Health Insurance. Improved knowledge in negotiations will provide a more accurate and realistic budget.