台灣地區65歲以上老年人口比例逐年攀升，人口的老化加上社會的變遷、疾病型態的改變，與醫療科技的發展，使得民眾的醫療照護費用不斷增加。為控制不斷成長的醫療費用，並透過逐步調整的給付方式，提升醫療照護服務速率與減少不必要的醫療費用支出，中央健保局在2010年1月1號起針對住院155項目實施住院「診斷關聯群支付制度」。為瞭解Tw-DRGs支付制度的實施成效，本研究的主要目的為觀察支付制度實施前後一年間，個案醫院之醫療服務利用、醫師診療行為與醫療品質之變化情形。研究採用回溯性分析，資料收集時間為2009年1月1日至2010年12月31日，針對南部某區域教學醫院分析比較Tw-DRGs實施前後之差異。Tw-DRGs實施後，住院醫療費用與申報費用點值均有顯著增加，其中以外科的成長率最高(142.2%)。在醫師診療行為方面，結果顯示Tw-DRGs實施後，平均每人每月住院醫療費用點值有顯著增加。在醫療品質方面，Tw-DRGs實施後，全院平均住院天數且病房週轉率下降，顯示個案醫院的全院住院醫療品質並未顯著提升。整體而言，Tw-DRGs支付制度的實施對個案醫院造成的影響，個案醫院應針對缺失提出改善策略，以因應Tw-DRGs之實施與達成醫院永續經營之目的。 Taiwanese elderly population is increasing to 10.6% in 2009. The medical expenses have continuously increased with ageing population, social changes, disease patterns, and medical technology. It is important to fine adjust payment system for reducing medical waste and increasing the efficiency of medial care. In order to control the increasing medical expenses, Bureau of National Health Insurance execute. The Tw-DRGs payment system for inpatients from 2010. The purpose of this study is to investigate differences between before and after the implementation of Tw-DRGs payment system in medical service utilization, physician behaviors and quality of care. A retrospective method was used to analyze data of a metropolitan hospital in southern Taiwan. Data were collected from January 1, 2009 to December 31, 2010. Results showed that inpatient expenses and benefit claims significantly increased after the implementation of Tw-DRGs payment system, and it was especially high in the surgery department (142.2%).The average medical expense of inpatients per month per person was also significantly increased. The quality of care of the case hospital was not significantly lifted after the implementation of Tw-DRGs payment system, because the average length of stay was increased and the turnover rate of beds was decreased. In general, the implementation of Tw-DRGs had a negative impact for the case hospital. Management strategies for the inpatient department should be emphasized to improve the quality of medical service and continuous hospital management.
