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研究生:黃俊喨
研究生(外文):Chun-Liang Huang
論文名稱:探討醫院對論病例計酬不同給付的選擇--以子宮完全切除術為例
論文名稱(外文):The study of hospitals choice operation methods with different case payment categories: A case study of hysterectomy
指導教授:劉見祥劉見祥引用關係陳世欣陳世欣引用關係
指導教授(外文):Chien-Hsiang LiuShih-Shin Chen
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:醫護管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
中文關鍵詞:論病例計酬醫院層級別醫院權屬別子宮完全切除術
外文關鍵詞:Case paymentHospital typeHospital ownershipHysterectomy
相關次數:
  • 被引用被引用:14
  • 點閱點閱:544
  • 評分評分:
  • 下載下載:44
  • 收藏至我的研究室書目清單書目收藏:5
背景:全民健保實施後為了控制醫療費用的上漲,陸續有50項的手術列為論病例計酬給付項目,腹腔鏡子宮切除術與傳統子宮切除術都是論病例計酬給付項目,但給付金額卻不同。不同層級別、不同權屬別醫院對此兩種手術方式的選擇是否有差別,其影響的因素又如何,以前未有研究探討過,此為本研究欲了解之處。
目的:探討不同層級、不同權屬別醫院如何選擇不同的手術方式,並探討可能影響選擇的因素。
資料來源:國家衛生研究院提供87、88年健保特約醫事服務機構,施行傳統式子宮切除術或腹腔鏡子宮切除術醫院及病例。
統計方法:除各變項關係分析外,以醫院層級別、權屬別為自變項並控制病患年齡、疾病嚴重度及年度,並以兩種手術方式為依變項,進行複迴歸分析。
結果:醫學中心較地區醫院、財團法人較公立醫院多採腹腔鏡子宮切除術,而地區醫院、公立醫院則較多選擇傳統式子宮切除術。醫院規模及利潤考量可能是影響手術選擇的因素。
Background: For the controlling the increasing of medical expensiveness, there are fifty operation procedures included as case payment items, such as laparoscopic hysterectomy and ahdominal (or vaginal) hysterectomy, but had different payment. Did the hospital type and ownership influence the choice of operation method? What’s the influence factor? No study has been on this field.
Object: Study how the different type and ownership of hospital choose the operation method, and the influence factors of choices.
Data source: Inculding all cases and hospitals which perfomed hysterectomy during 1998 and 1999, collected by National Health Insurance Research Database of National Health Research Institute.
Method: Using SPSS 10.0 as analysis tool, hospital type and hospital ownwership as independent variables, operation methods as dependent variables, age, case severity and year as control variables, we performed descriptive and regressive analysis.
Result: Medical center, non profit hospitals choice more laparoscopic hysterectomy than public hospitals. Local hospitals and public hospitals performed more abdominal (or vaqimal) hysterectomy. Hospital size and beneficence may be the factors which influence the hospital choose the operation method.
Conclusion: Hospital with large size has the incentive and ability to introduce new operation technique. After listing in case payment category, more hospitals would choose the operation method with different rate.
誌 謝I
中文摘要III
英文摘要IV
目 錄V
圖表目次VII
第一章 介紹與背景1
第一節 研究動機1
第二章 文獻探討3
第一節 醫療保險支付制度探討3
第二節 論病例計酬制度之探討5
第三節 不同子宮全切除術方法比較10
第四節 論病例計酬對醫院的影響12
第五節 醫院特質與醫療行為15
第三章 研究問題陳述18
第一節 研究問題18
第二節 研究目的19
第三節 研究假說19
第四章 研究材料和方法20
第一節 研究架構20
第二節 研究變項21
第三節 研究對象及資料來源23
第四節 資料分析24
第五章 研究結果25
第一節 研究樣本基本資料描述25
第二節 變項關係分析33
第三節 各變項對不同手術方式之複迴歸分析40
第六章 討論44
第一節 腹腔鏡子宮切除術列為論病例計酬給付項目44
第二節 住院日數減短及變異縮小45
第三節 疾病嚴重度46
第四節 年齡47
第五節 醫療費用47
第七章 結論與建議50
第一節 結論50
第二節 建議51
第三節 研究限制51
參考文獻53
中文部分53
英文部分56
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