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| 標題: | 模擬新制Tw-DRGs給付制度對醫院的衝擊與影響以慢性腎臟疾病之MDC5, MDC10, MDC11為例
Impact of Tw-DRGs-based payments on health care providers with simulation Model: The Example of Chronic kidney disease, CKD(MDC5, MDC10, MDC11) |
| 作者: | 黃得誌 |
| 貢獻者: | 醫務管理系
蕭如玲
陳瑞甫 |
| 關鍵字: | Tw-DRGs
模擬分析
慢性腎臟疾病
醫院財務影響
Taiwan-Diagnosis Related Groups (Tw-DRGs)
simulation analysis
Chronic kidney disease (CKD)
Impact of hospital financial |
| 日期: | 2019 |
| 上傳時間: | 2020-12-09 14:43:49 (UTC+8) |
| 摘要: | 目的:台灣中央健康保險署於2018年公告Tw-DRGs施行草案預計全面上線。實施至目前第二階段為止是以外科系為主的DRGs，未來上線的科系中，內科系的疾病複雜度相對高，其中慢性腎臟疾病（CKD）是屬於高風險疾病，也是名列國人十大死亡原因之一，更是全國醫療費用耗用第一名。綜觀以上原因，選定慢性腎臟疾病為研究標的，透過模擬導入Tw-DRGs 4.0支付系統下對醫院帶來的衝擊與影響之探討。
方法:採類實驗設計，收集個案醫院2017年01-12月共910筆慢性腎臟疾病資料，透過文獻資料與專家會議發展系統模擬架構，以進行系統模擬分析，再將模擬Tw-DRGs編審結果與實際醫療結果進行分析比較。
結果:（1）Tw-DRGs支付定額與醫療耗用，在疾病組合中單一高血壓患者與單一糖尿病患者之間有顯著差異。（2）CKD疾病嚴重程度對於Tw-DRGs支付定額與醫療耗用的影響，以MDC11組別皆有顯著差異。（3）整體系統模擬架構的預測性上，有56%解釋力；單一樣本MDC11解釋力為89%。
結論:新制Tw-DRGs 4.0版系統下對於醫療機構之影響衝擊是顯著的，包含支付定額因不同併發症之間產生差異性，在探討CKD疾病嚴重度的影響結果，驗證MDC11會因疾病嚴重度高低影響其費用差異，而本研究系統模擬架構選取的變數符合慢性腎臟疾病（CKD）樣本，但若系統模擬架構橫跨MDC5、MDC10，則其變數之選取尚需修正，以增強其模擬結果之預測性。
Objectives: In 2018, the National Health Insurance (NHI) Administration announced the Tw-DRGs (Taiwan Diagnosis-Related Groups) its full draft implementation. However, most of the Tw-DRGs implemented in the second stage were based on surgical divisions. Among the hospital specialties that have yet to implement Tw-DRGs, internal medicine is a specialty that deals with diseases that are often highly complex. In particular, the classification of CKD as a high-risk disease. In the past, CKD has become one of the 10 leading causes of death in Taiwan, as well as the costliest disease among the country’s top of medical resource utilization and expenses. Based on the aforementioned factors, CKD was selected as the subject matter of this study, while the impacts and effects of the Tw-DRGs 4.0 payment system on hospitals were examined through a model simulation of the system.
Method: An experimental design approach was adopted in this study, collect a case hospital data (January 2017 to December 2017), and total 910 CKD data. Based on the relevant literature summarized and analyzed, with revised and verified by experts. A system simulation framework was developed in this study; subsequently, the relevant variables within the framework were used to collect and archive the data. A simulation based on the new Tw-DRGs 4.0 system was then performed and the results were compared with the actual medical expenses data.
Results: (1) In terms of fixed benefits and medical resource utilization, a statistically significant difference with respect to case-mix groups was only observed between patients with only high blood pressure and patients with only diabetes. (2) In terms of the effects of CKD severity on fixed benefits and medical resource utilization, a statistically significant difference was only observed in the MDC11 group. (3) In terms of the predictive power of the overall system simulation framework, the explanatory power of the model was 56% while the explanatory power of the single MDC11 sample was 89%.
Conclusion: The results of this study indicated that the simulated Tw-DRGs 4.0 system had statistically significant effects on medical facilities, including differences in fixed benefits due to arising complications. Regarding the effects of disease severity, it was shown that CKD severity was linked to the cost differences in the MDC11 group. In this study indicating that the selected variables were appropriate for the CKD samples. However, the selection of variables must be revised if one intends to apply the system simulation framework to the MDC5 and MDC10 groups, so as to enhance the predictive power of simulation results. |
| 關聯: | 電子全文公開日期：2024-07-13
學年度：107，127頁 |
| 顯示於類別: | [醫務管理系(所)] 博碩士論文
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