利用組內相關係數評估台灣健保醫院總額實施之成效

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Title:	利用組內相關係數評估台灣健保醫院總額實施之成效 Using Intraclass Correlation Coefficient to Assess Effects of the Hospital Global Budget Payment System in Taiwan
Authors:	蔡麗淑
Contributors:	醫務管理系(所) 林為森
Keywords:	管制圖吉尼係數醫院總額支付制度迴歸分析組內相關係數 Intraclass correlation coefficient Gini coefficient control chart. hospital global budgeting regression analysis
Date:	2012
Issue Date:	2013-04-22 14:58:40 (UTC+8)
Abstract:	目的：健保於2002年7月實施醫院總額支付制度，每家醫院申報費用是否維持在一定的預算範圍內，勢需有個指標，如同吉尼係數用來評估一個國家財富分配是否均等，並藉以探討台灣的醫院，在2002年實施健保總額預算支付制度後，「個別」醫院總額預算支出的水準是否漸次維持不變？及醫院門診「個別」醫院總額預算支出的成果，是否不如其醫院住院？方法：利用國家衛生研究院發行之健保資料庫（1999至2009，共計11年）住院及門診費用總表，以費用資料完整的421家醫院當作樣本，132（=12月 × 11年）個月當作時間序列的觀察資料，以管制圖評定出各醫院10年120個月的偏離標準差（界於-4至+4），再計算出各年的組內相關係數（ICC），以探討層級醫院間預算控制的成果是否相同。另示範利用泡泡圖，呈現某月非預期超出管制的個別醫院之篩選作業。結果：過去10年的健保總額管制的成效，呈現顯著性地漸次變好，住院費用ICC由0.77降至0.42、門診費用由0.88降至0.61，顯示(1)在2002年實施健保總額預算支付制度後，「個別」醫院總額預算支出的水準，大致漸次維持不變，(2)自2005年起，醫院門診「個別」醫院總額預算支出的成果，不如其住院。泡泡圖示範出某月全國非預期超出管制界限的個別醫院之篩選。結論：組內相關係數可以成為每年比較與評估健保醫院總額實施之成效指標。建議每季召開醫院總額預算支付執行委員會的會議，能夠揭露其每年總額預算之組內相關係數，以報導此一每家醫院申報費用是否控制在一定預算範圍內的績效指標。 Objectives: Using a common indicator to assess effects on hospital global budget payment system implemented in 2002 in Taiwan is urgently required. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system, and compare what difference existed in the two sections of inpatient and outpatient in Taiwan’s hospitals Methods: Data from 1999 to 2009 regarding 421 hospital inpatient and outpatient medical reimbursements to Taiwan’s Bureau of National Health Insurance (BNHI) were used to examine the extent of monthly unexpected values in a range from -4 to 4 standard deviations applying the statistical process control chart to the nation-based 120 months’ reimbursement datasets in the past 10 years. Intraclass correlation coefficients (ICC) were hence annually obtained to inspect whether global budgets were well controlled among hospitals in different sections. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system. Results: ICCs were generated for Taiwan's year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.77 to 0.42 and from 0.88 to 0.61 in inpatient and outpatient sections, respectively. We found that 1) the effect on hospital global budget payment system was gradually improved in past 10 years; 2) inpatient sector showed significantly more well-controlled than its outpatient counterpart. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period. Conclusions: ICC could be the indicator used for annually assessing effects on hospital global budgeting. We suggest the committee in charge of monitoring hospital global budgeting reveal the ICC to report annual effects on carrying out the hospital global budgeting in a specific controlled limit range
Relation:	校內外均一年後公開，學年度：100，89頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

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