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研究生:仲偉靜
研究生(外文):Chung , Wei-Ching
論文名稱:三項外科手術之成本分析
論文名稱(外文):The cost analysis of three selected surgical procedures
指導教授:邱亨嘉邱亨嘉引用關係
指導教授(外文):Chiu, Herng -Chia
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:公共衛生學研究所碩士在職專班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:101
中文關鍵詞:腹腔鏡膽囊切除手術冠狀動脈繞道手術脊融合併植入物手術手術總成本
外文關鍵詞:laparoscopic cholecystectomycoronary artery bypass graftlumbar fusion with instrumentationtotal cost
相關次數:
  • 被引用被引用:1
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  • 收藏至我的研究室書目清單書目收藏:2
摘 要
本研究之目的在探討某醫學中心和區域醫院三項手術成本,以健保支付之手術碼,回溯性在兩家醫院選取三種手術個案 : 腹腔鏡膽囊切除手術(75215B),冠狀動脈繞道手術(68023A,68024A,68025A),脊椎融合並植入物手術(83046B),計算手術個案到達手術室,從進入到離開手術室這段期間的相關成本,並比較兩家醫院的差異,期能提供醫院管理者,保險機構,瞭解資源運用的適切性。在兩家醫院醫學中心及區域醫院的收案數分別是 : 腹腔鏡膽囊切除手術76 人:35人,冠狀動脈繞道手術 96人:30人,脊融合併植入物手術59人:45人,統計方式採用獨立樣本t-test, ANOVA及迴歸分析成本相關資料,手術成本資料包括有: 手術醫師成本,麻醉醫師成本,手術護理人員成本,麻醉護理人員成本,藥品成本,材料成本,房屋折舊,行政管理成本,儀器器械折舊費用,檢驗成本,輸血成本,病理成本,研究結果有四:
(一)、在單一手術總成本於醫學中心和區域醫院分別是 : 腹腔鏡膽囊切除術(22,014元 : 26,334元) ,冠狀動脈繞道手術(170,444元: 214,944元),脊融合手術成本(106,862元: 87,642元),即腹腔鏡膽囊切除術和冠狀動脈繞道手術是醫學中心較區域醫院成本較低 ,但只有脊融合併植入物手術成本醫學中心比區域醫院總成本更高 。
(二)、在個別醫師的差異性,結果在同手術中腹腔鏡膽囊切除術和冠狀動脈繞道術手術量最多者,手術時間越短且成本越低。
(三)、並分析醫院間各項成本的比例,在醫學中心和區域醫院皆以材料成本最高,次為主治醫師成本,且手術護士成本高於麻醉護士成本。
(四) 、三種手術經由迴歸分析以「手術時間」均能預測總成本。
因此對每種手術類別應建立成本分析,以提供健保局給付之參考;醫院管理者應加強手術醫師之熟悉度,包括團隊分工合作,縮短手術時間,及材料管理,以降低機構內之各項成本,宜以其他醫院為借鏡,並深入探討改善的方法,將能有效提昇醫院之競爭力。
Abstract
The purpose of this study is to investigate the costs of three selected surgical procedures performed in a medical center and a county hospital. Based on the procedure codes used by the central health department, patients with any of the following three procedures were selected from those two hospitals: laparoscopic cholecystectomy (LC: 75215B), coronary artery bypass graft (CABG: 68023A, 68024A, 68025A), and lumbar fusion with instrumentation (RF: 83046B). All related cost incurred during a patient’s stay in operation room (OR) was compared between the two hospitals. The findings of the study will provide management teams and insurance carriers useful information on the appropriate use of resources.
Number of cases selected for LC was 76 in the medical center and 35 in the county. 96 people had CABG in the medical center, and 30 in the county. 59 people had RF in the medical center, and 45 in the county. Independent t test, ANOVA, and regression analysis were used to analyze cost related information. Costs for surgeons, anesthesiologists, nursing staff, drugs, surgical supplies, administration and management, depreciation of buildings, monitors, and surgical equipments, maintenance and repair, laboratory, blood transfusion and pathology were included in the study. The following are major findings for the study:
1.The total cost for LC was NT$ 22,014 in the medical center and NT$ 26,334 in the regional, NT$ 170,444 for a CABG patient in the medical center and NT$ 214,944 in the regional, NT$ 106,862 for RF in the medical center but 87642 in the county. Both costs for LC and CABG were lower in the medical center, and only the cost for RF was lower in the regional.
2.Result also indicated that surgeons who had performed a greater number of LC and CABG procedures used less time for the same procedure, and thus, cost was reduced.
3.Surgical supplies were the highest cost for the medical center and the regional hospital following by the costs for primary surgeon. Result also indicated that the costs for OR nursing staff were higher than that of the anesthesia nurse.
4. The results of regression analysis find the surgical time of three selected surgical procedures can predict total cost.
Cost analysis should be performed for every surgical category, which will provide Center of Health Insurance baseline information for claim payment. To reduce overall internal costs, hospital management team should try to improve surgeons’ proficiency in surgical procedures, encourage joint efforts in surgical teams, shorten surgical time, and manage supplies. To promote competitiveness, hospitals should also learn from each other’s and develop constructive measures to cut costs.
目 錄
第一章 緒 論
第一節 前言 2
第二節 研究背景 3
第三節 研究動機 5
第四節 研究目的 6
第五節 預期貢獻 7
第二章 文獻探討
第一節 介紹三項手術 9
第二節 成本定義與成本分析的目的 16
第三節 探討影響手術成本的因素 22
第三章 研究設計
第一節 研究架構與研究設計 31
第二節 研究假設 35
第三節 研究變項與操作型定義 35
第四節 研究材料與方法 38
第五節 資料處理與統計分析方法 42
第四章 研究結果
第一節 腹腔鏡膽囊切除手術直接
及間接成本分析 44
第二節 腹腔鏡膽囊切除手術各項
成本分析 47
第三節 腹腔鏡膽囊切除手術不
同醫師之病患及成本分析 51
第四節 腹腔鏡膽囊切除手術病患
機構因素、病患基本屬性、
手術特性及手術癒後分析 53
第五節 冠狀動脈繞道手術直接
及間接成本分析 59
第六節 冠狀動脈繞道手術各項
成本分析 62
第七節 冠狀動脈繞道手術不同
醫師之病患及成本分析 66
第八節 冠狀動脈繞道手術機構因
素、病患基本屬性、手術
特性及手術癒後分析 68
第九節 脊椎融合併植入物手術
直接及間接成本分析 74
第十節 脊椎融合併植入物手
術各項成本分析 76
第十一節 脊椎融合併植入物手術
不同醫師之病患及成本分析 80
第十二節 脊椎融合併植入物手術病患
機構因素、病患基本屬性、
手術特性及手術癒後分析 82
第五章 討論及建議
第一節 討論 88
第二節 建議 91
第三節 研究限制 92
參考文獻 101
圖 表 目 錄
表目錄
    
表2-2-1 成本分類與內容 19
表2-2-2 依可溯性之成本分類 20
表2-2-3 依組織功能的成本分類 21
表2-3-1 ASA score 評分表 24
表2-3-2 影響成本因素之文獻摘要 27
表3-3 各類變項及操作型定義 37
表4-1 腹腔鏡膽囊切除手術直接及間接成本分析 46
表4-2 腹腔鏡膽囊切除手術各項成本分析 50
表4-3 腹腔鏡膽囊切除術不同醫師之病患及成本分析 52
表4-4-1 腹腔鏡膽囊切除手術病患機構因素、
病患基本屬性、手術特性及手術癒後 56
表4-4-2 腹腔鏡膽囊切除手術總成本迴歸分析 57
表4-5 冠狀動脈繞道手術直接及間接成本分析 61
表4-6 冠狀動脈繞道手術各項成本分析 65
表4-7 冠狀動脈繞道手術不同醫師之病患及成本分析 67
表4-8-1 冠狀動脈繞道手術手術病患機構因素、
病患基本屬性、手術特性及手術癒後
總成本迴歸分析 71
表4-8-2 冠狀動脈繞道手術總成本迴歸分析 72
表4-9 脊椎融合併植入物手術直接及間接成本分析 75
表4-10 脊椎融合併植入物手術各項成本分析 79
表4-11 脊椎融合併植入物手術不同醫師之病患及成本分析81
表4-12-1 脊椎融合併植入物手術病患機構因素、
病患基本屬性、手術特性及手術癒後分析 85
表4-12-2 脊椎融合併植入物手術總成本迴歸分析 86
圖目錄
圖2-1-1 腹腔鏡膽囊切除手術刀口位置圖 10
圖2-1-2 心臟解剖圖 12
圖2-1-3 椎融合併植入物模型圖 16
圖 3-1 研究架構Ⅰ 33
圖 3-2 研究架構∐ 34
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