| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學研究所碩士在職專班 === 91 === 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.
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