全民健保是為了使民眾都能獲得公平的醫療服務而實施，然而健保開辦至今，醫療支出年年增加，為了抑制醫療費用的急速增加，中央健保局於民國2010年1月1日開始實施Tw-DRGs支付制度。為了瞭解Tw-DRGs支付制度實施前後的醫療利用情形，以及Tw-DRGs支付制度對於醫院財務的影響，本研究以南部某區域教學醫院的骨科2009年與2010年之住院病患為研究對象，利用SPSS 18.0版進行統計分析。本研究結果顯示樣本醫院骨科的醫療服務使用者以女性多於男性，年齡層以中高年齡者居多。實施Tw-DRGs支付制度之後，住院天數下降，自費占定額的比率有降低的趨勢。雖然導入後實際的住院醫療服務點數落入定額支付區的案件數占97.56%，但是，由於CMI值偏高，而其BR值並未相對的提高，恐對醫院財務帶來不利的影響。多元迴歸分析發現住院醫療費用會受到病患年齡、住院天數、年度的影響。 Due to the substantial increase in health care expenditure, Bureau of National Health Insurance (BNHI) applied the Tw-DRGs payment system to inpatients starting in January, 2010. This study intended to explore the difference of health service utilization before and after the implementation of Tw-DRGs, using data derived from a southern Taiwan Regional Teaching Hospital. Our results showed that orthopedic inpatients exhibited more female than male, and the age of 65-74 years had the highest proportion of orthopedic inpatients. After the inauguration of Tw-DRGs payment system, the length of stay (LOS) and the self-pay to fixed payment rate decreased. After introducing the system, the case falling into the area of fixed payment was 97.56%. The CMI value of the hospital in this study was higher than the other medical care facilities, but its BR was not, which might induce financial risk. The result of multiple regression analysis showed medical expenditures are explained by age, LOS, and year.
