| Summary: | 碩士 === 國立成功大學 === 工學院工程管理專班 === 92 === Compared with the main countries of Organization for Economic Co- Operation and Development (OECD), hospital in Taiwan tends to a low density and centralization, but the amount of outpatients has a tendency toward great quantity. It’s imperative for Taiwan''s healthcare authority to restrain the growth of medical expense as well as to maintain the medical service quality. Since the medical fee review and claim deduction are the most important topics to the payment system of the Bureau of National Health Insurance (BNHI), therefore, how to avoid being deducted is becoming the target to most medical institutions.
This paper is based on the data of reimbursement expenditure in outpatient and emergency service withdrawn by BNHI from a medical center in southern Taiwan. It has been run via SPSS and Access software to the integration analysis, planning and exploration, such as Frequency Distribution Analysis (FDA), Analysis of Variance (ANOVA), Scheffe differential equations test, Linear Regression Analysis (LRA).
As a result of analysis, we find that antibiotics, breast cancer, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) are the factors of deduction in expensive medical fee and high deduction rate. Furthermore, by means of Informatics Technology’s (IT) Business Process Re-Engineering (BPR), the differentia before and after the process through T-test is came out. We obtain the rate of deduction has significant improvement — the reduction of antibiotics has dropped off about 28% while CT and MRI about 31%. Meanwhile, the surplus is increasing through the continuing supportive caring model of breast cancer.
Taking advantage of IT to monitor doctors'' abuse in prescribing drug and then refrain from recommitting the same errors of being deducted. We also emphasize that each hospital should to attain the BNHI required indicators by the BPR approaches. Thus, all the procedures regarding to deduction, reply, disputations will be smoothly streamlined and the quality of medical service no wonder will be promoted as well.
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