The Pilot Study on Developing Case Payment System for Inpatient Rehabilitation: A Case Study on Stroke in four Hospitals in Taiwan.

• Main Authors: Darren Liu, 劉大任
• Other Authors: Pai Jar-Yuan
• Format: Others
• Language: zh-TW
• Published: 1999
• Online Access: http://ndltd.ncl.edu.tw/handle/44224829759782973880

碩士 === 中國醫藥學院 === 醫務管理研究所 === 87 === To develop a more suitable payment system for inpatient medical rehabilitation in Taiwan for controling the increasing payments to rehabilitation facilities under NHI (National Health Insurance) is a quite hard-work for legislative and administrator. Many foreign study tried to find out the predictors of resource utilization but the aspect of these studies in Taiwan are still absent. This study tries to explore the suitable scheme by referring to the experience of any other medical specialist and countries. First part of this study is to explore the difficults of implementation of Prospective Payment System (PPS) for inpatient medical rehabilitation under NHI by reviewing related paper and to make some advanced advices for reorganizing payment system in the future. Second part of this study is to analysis 997 medical fee of four hospitals (include medical center, rehabilitation teaching hospital, regional hospital, and quasi medical center) charged by NHI in Taiwan. The conclusion of this study is describing as below: 1. It is necessary to developing a case-mix system for inpatient rehabilitation before an appropriate PPS for rehabilitation can be developed and implemented. 2. The future trend of developing payment system of inpatient rehabilitation is towards applying to functional independence measurement (FIM) and hospitals be paid according to functional gain. 3. Besides acute care in rehabilitation, it is necessary to provide patients with a optimum continuous medical care by combining subacute care and other long-term care. This study also analysis total medical fee, physical therapy fee, and drug fee of stroke patients by using multiple regression. The results is that: 1. Since older patients have higher prevalence of cerebral infarce (CI) and the medical fee of CI is less, the increase in expected total medical fee is increasing by independent variable--age. The total medical fee is increasing by length of stay (LOS) significantly. 2. Rehabilitation hospital has higher physical therapy fee than others. The physical therapy fee of CI is higher than cerebral hemorrhage (CH), which is due to clinical CH patients always serious and referral from ICU. 3. Clinical CH has more complications and comobidities, i.e. hypertension, diabetes etc. This study found that drug fee of CH is also higher than CI. This study also tried to calculate the total medical fee of inpatient rehabilitation, which can be the references before NHI negotiate the payment rates with hospitals.