The Development and Evaluation of the Decision Support for Hospitalization and Treatment Payment Auditing

• Main Authors: Chao Jui-hua, 趙瑞華
• Other Authors: 洪新原
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/38991488954056049436

碩士 === 國立中正大學 === 資訊管理學系 === 91 === The study takes the inpatient databases of hospitals/clinics of the Central Taiwan Branch of the National Health Insurance Bureau as the grounds to develop a decision support system for hospitalization and treatment payment auditing. It is intended to find ways to economize labor costs of review and strengthen the review performance and efficiency. In turn, it will strive for unanimity and equality of review to upgrade medical service quality and improve medication behaviors. The study employs Visual Basic to develop a decision support system for substantial enforcement with the inpatient databases of the Central Taiwan Branch of the National Health Insurance Bureau. It assesses the systematic efficiency and effects of the survey for user satisfaction. The primary findings yielded through the study are concluded as follows: 1.In terms of the results analyzed through effects in the generalized medical instruction cluster review, the decision support system for hospitalization and treatment payment auditing outperforms the manual review. The inpatient databases of the Central Taiwan Branch of the National Health Insurance Bureau as of November 2002 were screened for abnormalities through both decision support system for hospitalization and treatment payment auditing outperforms manual review. In all cases of the number of abnormal cases and amounts so sorted out or number of abnormal cases and amounts sorted out in a same medical order, the inpatient review decision support system outperforms manual review. 2.In terms of efficiency, in time, reduced labor, and economized costs for the review, the decision support system for hospitalization and treatment payment auditing yielded better effects than manual review. 3.The survey results indicate that the mean score of user satisfaction is 6.03 (The items were measured using a 1-7 seven-points Likert-type scale.). That is, users are highly satisfied with the decision support system. In Taiwan, medical charges are primarily reviewed manually. The determination of the cases of review by means of sample check is inevitably unfair and inconsistent. Moreover, it also calls for numerous labor and administrative costs. The results of this study prove that the system brings significant effect in review results, efficiency, and user satisfaction, and yields positive results in fair review, unanimity and upgrade of medical services. Nevertheless, the decision support system should be positioned as a help to reviewers in manual work under the existing review process.