| Summary: | 碩士 === 亞洲大學 === 健康管理研究所 === 94 === Foreword:
In Taiwan, about the implementation of National Health Insurance, the most important meaning is aimed to benefit countless members of the disadvantaged minority to reach the goal of helping each other in the society. People from various fields sincerely hope for the eternal operation of National Health Insurance. Thus, the reform of payment systems is naturally the inevitably required process. The Bureau of National Health Insurance（BNHI）is now planning to introduce the DRG payment systems with an effort to sooth financial problems. In 2004, the Tw-DRG plan draft had been publicized.
Purpose:
Within this research, by using the data derived from national health insurance database, we carry out statistical analysis to inspect whether the currently projected Tw-DRGs V3.0 Payment Draft can comply with the payment logics of disease seriousness? Also, by using the said classification methods, we explore the correlation among Length of Stay, disease seriousness and medical expenditures.
Method and material:
The data source is retrieved from the inpatient claims of National Health Insurance in 2004. After compiled and analyzed statistically by Tw-DRGs, the major questions to be asked:
1. By Tw-DRGs, how much variation of medical expenditures can be explained? Is there any correlation between Length of Stay and medical expenditures?
2. Is there any correlation between disease seriousness (DRG relative weight) and Length of Stay ?
3. Is there any influence for hospital characteristics to affect Length of Stay , disease seriousness and medical expenditures?
4. Is there any influence for patient characteristics and hospital characteristics to affect Length of Stay and medical expenditures?
Result:
Medical expenditures and Length of Stay : Patient characteristics such as genders and ages, together with hospital characteristics such as levels of hospital, come with the significant different in average medical expenditures and Length of Stay . The medical centers come with higher Length of Stay and medical expenditures higher than those of other levels of hospitals. The public hospitals come without variance between the hospitals of fund juridical persons. The branch-leveled Taipei Branch and East District Branch come without significant variance in medical expenditures mutually.
Disease Seriousness (CMI): It exists in no significant variance among various ownership of hospitals. The patients treated by the hospital accreditation levels medical centers come with higher seriousness than that of patients from other levels of hospitals. The result is similar to past researches made by other overseas organizations.
Conclusion:
1. The explanation strength for Tw-DRGs medical expenditures of no extreme value eliminated is rated at 49.84%. The value after extreme values eliminated is 58.05% and it is similar to those results made by overseas organizations. It reveals that the said Tw-DRGs are availably used as the payment method.
2. It comes with large variance for Tw-DRGs medical expenditures with inferior internal congruence within every DRG group. Results are similar to those made by overseas organizations. Thus, the Tw-DRGs classified payment could possibly confront the opportunistic events the same as the overseas environment. (DRG Creep)
3. Within the same DRG, hospitals from various levels come with the significant variance in medical expenditures. It reveals that it is basically required for further adjustment if the relative weight (RW) of Tw-DRGs is applied to hospitals from various levels.
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