健保局自1997年對人工全髖關節置換術與人工全膝關節置換術實施論病例計酬以來，整體醫療費用逐漸下降，下降的是哪些醫療項目呢? 本研究是透過國家衛生研究院健保資料庫擷取人工全髖關節置換術與人工全膝關節置換術住院資料進行分析，以了解論病例計酬實施十年後，醫療費用的變化。我們擷取2000-2001年及2010-2011年兩個時間的人工全髖關節置換術與人工全膝關節置換術住院資料，經分析比較發現，十年間整體醫療費用下降，住院天數下降，藥費下降，但是檢查檢驗費及放射線檢查費並沒有顯著改變，麻醉費用也沒有改變，顯示對病人狀況的掌握及照顧並沒有受到影響。手術費與特殊材料費是由健保局律定的金額，因此也沒有改變。論病例計酬實施後十年間的人工全髖關節置換術與人工全膝關節置換術案件數增加，顯示民眾對這兩個手術的接受度提高，醫界也藉此收益增加，健保局也達到醫療費用下降的目的。

From 1997, the National Health Insurance Bureau (NHIB) started case payment of Disease-Related Group (DRG) for total hip arthroplasty and total knee arthroplasty. The total medical costs showed a declining trend. However, which items of medical service became less? The study used NHIB database to obtain inpatient data of total hip arthroplasty and total knee arthroplasty for analysis of medical costs. We retrieved inpatient data of total hip arthroplasty and total knee arthroplasty from 2000-2001 and 2010-2011. After analyzing, total medical costs showed decreased and also length of stay, pharmacy fees. But the laboratory tests fees and radiologic examinations fees and anesthesia fees were not changed. It meant the monitoring of patients’ condition was not influenced after DRG implement. The charge for surgery and costs of prosthesis were regulated by NHI, so these fees were not changed. After implement of DRG by ten years, the numbers of total hip arthroplasty and total knee arthroplasty showed increased. It meant these surgeries were more popular than before. The benefits for hospital might be increased due to increased numbers. The total medical costs were also decreased as NHIB expected.

誌謝 ………………………………………………………… i
中文摘要 …………………………………………………………… ii
英文摘要 …………………………………………………………… iii
目次 ………………………………………………………………… iv
表目次 ……………………………………………………………… vi
圖目次……………………………………………………………… vii
第一章 緒論
第一節 研究動機與動機 ………………………………… 1
第二節 研究目的 …………………………………………… 1
第三節 研究問題 …………………………………………… 2
第二章 文獻探討 …………………………………………… 3
第一節 健保局支付制度 ………………………………… 3
第二節 台灣住院醫療利用情形之相關實證研究………… 5
第三節 全髖關節置換手術及全膝關節置換手術介紹…… 5
第三章 研究方法 ………………………………… 8
第一節 資料收集 ………………………………………… 8
第二節 研究架構 ……………………………………… 11
第三節 研究流程圖 ……………………………………… 12
第四節 資料處理與分析方法 …………………………… 13
第四章 研究結果 .……………………….……… 14
第一節 人工全髖關節置換術 .................. 14
第二節 人工全膝關節置換術 ................... 17
第五章 討論 .………………………………… 21
第一節 性別及年齡.......................... 21
第二節 住院天數 ............................21
第三節 診察費與病房....................... 22
第四節 檢查費與放射線檢查費.................23
第五節 治療處置費、復健治療費................23
第六節 手術費、特殊材料費.................... 24
第七節 藥費、藥事服務費....................... 25
第八節 麻醉費................................. 25
第九節 醫療費用............................... 26
第六章 結論與限制 …………………………………. 27
第一節 結論 …………………………………………… 27
第二節 限制 …………………………………………… 27
參考文獻........................................ 28

1.Richmond JC. Surgery for osteoarthritis of the knee. Rheum Dis Clin North Am. 2013 Feb;39(1):203-11
2.張佳琪 黃文鴻 健保支付制度對全髖及全膝關節置換手術醫療利用情形之影響 台灣衛醫 2001:20(6):440-50
3.H.-C. Chiu, H.-Y. Shi, L.-W. Mau et al. The effects of a prospective case payment system on hospital charges for total hip arthroplasty in Taiwan
4.Focus on value-based purchasing to help your hospital succeed. Hosp Case Manag. 2013 May;21(5):57-9.
5.http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=660&webdata_id=2091&WD_ID=672
6.C.A. Jones, L.A. Beaupre, D.W. Johnston et al. Total joint arthroplasties: current concepts of patient outcomes after surgery Rheum Dis Clin North Am. 2007 Feb;33(1):71-86.
7.Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Clin Geriatr Med. 2005 Aug;21(3):527-41
8.Yamabe E, Ueno T, Miyagi R, Watanabe A, Guenzi C, Yoshioka H. Study of surgical indication for knee arthroplasty by cartilage analysis in three compartments using data from Osteoarthritis Initiative (OAI). BMC Musculoskelet Disord. 2013 Jun 25;14:194
9.Cheng TM.Taiwan’s new national health insurance program: Genesis and experience so far Health Aff (Millwood). 2003 May-Jun;22(3):61-76.
10.http://w3.nhri.org.tw/nhird//talk_02_view.php?list_n=310&fnum=310
11.S. Kurtz, M. Mowat et al. Prevalence of primary and revision total hip and total knee arthroplasty in the United States from 1990 through 2002 J Bone Joint Surg Am 2005: 87(7): 1487-97
12.Falbrede I, Widmer M, Kurtz S, Schneidmüller D, Dudda M, Röder C. Utilization rates of lower extremity prostheses in Germany and Switzerland: A comparison of the years 2005-2008 Orthopade. 2011 ;40(9):793-801
13.Dunlop DD, Manheim LM, Song J, Sohn MW, Feinglass JM, Chang HJ, Chang RW. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Med Care. 2008 Feb;46(2):200-8.
14.Mota RE, Tarricone R, Ciani O, Bridges JF, Drummond M. Determinants of demand for total hip and knee arthroplasty: a systematic literature review BMC Health Serv Res. 2012 Jul 30;12:225.
15.Judge A, Welton NJ, Sandhu J, Ben-Shlomo Y. Equity in access to total joint replacement of the hip and knee in England: cross sectional study BMJ. 2010 Aug 11;341:c4092
16.Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008 Dec;51(6):428-36.
17.S.J. Meyers, J.D. Reuben, D.D. Cox et al. Inpatient cost of primary total joint arthroplasty J Arthroplasty 1996; 11(3): 281-6
18.D.L. Boardman, J.R. Lieberman, B. Thomas Impact of declining reimbursement and rising hospital costs on the feasibility of total hip arthroplasty J Arthroplasty 1997;12(5): 526-34
19.W.L. Healy, R. Iorio, J.A. Richards et al. Opportunities for control of hospital costs for total joint arthroplasty after initial cost containment J Arthroplasty 1998;13(5): 504-8
20.Zhang Y, Zhang H, Clarke HD, Hattrup SJ. Analysis of total joint arthroplasty costs in Chinese patients. J Arthroplasty. 2012 Sep;27(8):1423-1428
21.Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M et al. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil. 2012 Feb;93(2):192-9