| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 95 === Abstract
Objectives
The aim of this research was to investigate the annual income of three southern medical centers for the first year in which six major diagnostic categories were introduced (MDC3, MDC9, MDC11, MDC13, MDC23, MDC24). It also aimed to investigate the important factors influencing the costs of hospitalization.
Methods
As a retrospective study, this research including the 2004~2006 “Hospitalization Treatment Costs” files of three southern medical centers, investigate cases of 83,060 from the DRG review service and disbursement formula to study financial income by year and by hospital, the Case Mix Index (CMI), the average per person cost of hospitalization, the average number of days of hospitalization, diagnosis encoding and comorbidity(complication) disease encoding.
Results
Of the six annual MDC financial income indices, MDC3, MDC9, MDC11and MDC13 had the greatest influence on different hospitals. In different hospitals and different areas of specialization, That main clinical areas of specialization have a greater influence on MDC financial control than non-specialist areas. Except for MDC24, the diagnosis encoding of the other MDCs showed a situation of annual increase. MDC3, MDC9, MDC11 and MDC13 comorbidity(complication) disease encoding also showed a tendency to increase on an annual basis. For the Case Mix Index (CMI), the average cost per person of hospitalization, and the average number of days of hospitalization in different years and hospitals, different MDC’s had different interactive influences.
After controlling for differences in age and gender, the research shows that the average number of days of hospitalization, the Case Mix Index (CMI), the diagnostic encoding, and the comorbidity(complication) disease encoding are all important factors influencing the cost of hospitalization, with R2 reaching 61.8%.；AMOS showed that Utilization (average number of days of hospitalization and hospitalization Case Mix Index) and Coding (analysis encoding and comorbidity(complication) disease encoding) may be used to forecast medical expenses, and the medical costs may be used to forecast financial income targets.
Discussion and Suggestions
According to the third version of the DRG disbursement framework, the financial income index for the six MDCs falls between 0.01~0.06. Duplicate regression analysis demonstrated that the average number of days of hospitalization, the Case Mix Index, the diagnostic encoding and the comorbidity(complication) disease encoding are all important factors influencing the cost of hospitalization. The hospital superintendent should regard the service quality of medical care, control the length of days of patient in reasonable, and improve the coder of hospital with constant practice during the implementation of DRG in the future. The medical superintendent by the government should also establish the investigation system to survey the results of DRG and be sure the appropriate medical care of our people.
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