以資料包絡分析法探討Tw-DRGs支付制度下外科醫師行腹腔鏡膽囊切除術之效率

Exploring the Efficiency of Laparoscopic Cholecystectomy for Surgeons under the Tw-DRGs Payment System by Data Envelopment Analysis

目的：旨在探討某院外科醫師行腹腔鏡膽囊切除術其醫療效率，將高效率醫師的處置方式供其他醫師參考，讓醫院能達到高效率高品質。方法：本研究透過病歷回顧及健保醫療申報資料，收集南部某區域醫院於2015至2018年接受腹腔鏡膽囊切除術之住院個案為研究對象，以資料包絡分析法分析，將平均住院醫療費用點數及平均住院天數當作投入變項，個案數、平均申報醫療費用點數及平均權重當作產出變項，探討執行手術醫師的醫療效率。結果：研究對象共有1,323例，以一般外科695例最多（52.5%）；消化外科624例（47.2%）；其他科4例（0.3%）。以H醫師570例（43.1%）、A醫師329例（24.9%）、B醫師159例（12%）為手術量前三名。以資料包絡分析法求效率值，H醫師效率值為1，表示相對有效率。結論：以資料包絡分析法探討執行手術醫師的醫療效率，結果顯示H醫師效率值為1，表示相對有效率。因此，建議可以將H醫師的醫療處置方式作成標準作業模式，在一般外科及消化外科討論會中做分享，建議醫院可以以此模式廣泛運用在其他手術上，以提升醫療品質及作為醫療費用與住院天數的管控。

Objective: To explore the medical efficiency of laparoscopic cholecystectomy performed by surgeons in a hospital, and to provide other physicians with reference to the treatment methods of high-efficiency physicians, so that the hospital can achieve high efficiency and quality. Methods: This study collected the inpatient cases of laparoscopic cholecystectomy from 2015 to 2018 in a regional hospital through medical record review and health insurance declaration data. The days of hospitalization were used as input variables, and the number of cases, average declared medical expenses and average weights were used as output variables to explore the medical efficiency of the performing surgeons. Results: A total of 1,323 cases were studied, with 695 cases (52.5%) in general surgery, 624 cases (47.2%) in gastroenterology and 4 cases (0.3%) in other departments. The top three surgeons in terms of volume were Dr H (570 cases) (43.1%), Dr A (329 cases) (24.9%) and Dr B (159 cases) (12%). The efficiency value of Dr. H was 1, indicating the relative efficiency. Conclusion: The results of the analysis of the efficiency of surgeons showed The analysis results on surgeons' efficiency indicated that the efficiency value of Dr. H was 1, indicating a relative efficiency. Therefore, it is recommended that Dr. H's medical treatment can be made a standard practice and shared in the general surgery and gastroenterology symposiums. It is recommended that this model can be widely applied to other surgeries to improve the quality of care and control medical costs and hospitalization days. Keywords: International innovation capability, Innovative organizational culture, Consumer culture, Cooperative innovation, Multinational advantages.