精神科病房治療費持續監測改善方案

Contunuous Monitoring Treatment Fee in Inpatient Psychiatric Wards

自84年實施全民健保以來，內外科紛紛成立健保因應小組、檢討收支，以達成本控制目標。精神科因治療項目較不易量化，故至86年，所訂之治療費用收費標準因不夠清晰明確、醫護間做法不一致，亦未有系統性帳目查核、醫療人員成本概念也未全面建立，導致漏帳情形嚴重，收入偏低。本專案運用系統理論，實施步驟為：評估、計劃、執行、評值四期進行，自86年8月至87年12月間，積極參與科內健保小組會議，與各類醫療人員，經多次溝通討論，找出科學化數據，制訂標準化健保收費說明單、加強醫護人員成本概念、定期參與帳目查核，目前已達到精神科三個急性病房1.有明確統一之治療費記帳標準2.定期系統查核帳目3.醫護成本概念提昇4.八十七年病房治療費收入較八十六年增加362萬元，平均每月增加30萬元。也因明瞭查帳缺失而得以1.建議資訊室將治療費收入由原先統一登錄於科內改為分別呈現於各病房成本月報內，更利於帳目查核2.此健保收費說明單於日後健保對精神科實施總額制給付時得以快速而有效因應。

Medical and surgical departments have established health insurance responding team one examined revenue and they have expenditures for controlling the target in cost form enforcing national health Insurance since 1995. Psychiatric wards failed to auantinrize account seriously and had low revenue until 1997 because it was hard to measure the numbers of care, and the charge standards of treatment fees were not clear, the criteria between the doctors and the nurses was not the same, the lackatic of stematical account, and the cost for the doctors and the nurses was also not also set up. System theory was used in this project, including the following four steps-Assessment, plan, execute and evaluate. We participated in the team meetings for health insurance positively, having communicated with doctors and nurses and gathered scientific data. We also instituted the standards between doctors and nurses and checked the items of account regularly. Now, the above works were achieved in three acute wards among psychiatric departments. 1) There is a clear and identical standardized accounting in treatment fees. 2) There's regular systematic investigation account. 3) The idea of the cost using between doctors and nurses has been promoted. 4) The revenue of the treatment fees of wards in 1998 was NT$3,620,000 more than those in 1997 increased by NT$300,000 in average per month. At the same time, we realized the deficiency in audit: First, we have suggested the computer center that monthly statements for the three acute wards, should be changed from the combined statement of psychiatric department to separate statements for three wards independently. Second, the instruction for the charge of health insurance should be responded to global budget soon and more effectively.