The impact of DRGs System to the Hospital Payment under NHI Scheme-Hospitals on Taichung area as an Example

• Main Authors: Liao chin chên, 廖錦珍
• Other Authors: Yang han chüan
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/13316970971861616969

碩士 === 亞洲大學 === 健康管理研究所 === 95 === Reform of payment system is a common method used to increase medical efficiency, improve quality of care and contain medical cost in most countries. Since the implementation of National Health Insurance in Taiwan, on March 1st, 1995, there are frequent reforms in payment systems. Moreover, the Diagnosis Related Grouping (DRGs) payment，will be imposed on hospital care under the global budget system since January, 2008. On account of the big gap between service functions, there might have obvious differences facing to the degree of financial impact on different specialty hospitals after the implementation of DRG/PPS. From this point of view, we want to study the payment system of Taiwan. Using the 2004 national health insurance databank, we adapt the National Health Insurance bureau processing-inspection formula to process the DRG,calculate the DRG dropping point, applied medical fees and analysis of all hospitals located on Taichung county and city. The patients in medical centers have more average hospital days and medical fees than the other level hospitals, In other words, medical centers will be underpaid after the implementation of DRGs.After DRGs implement, the different ownership of hospital also influence by the National Health Insurance payment system. But the influence is less than the level of hospitals. The different ownership is influenced mainly comes from the different mix of hospital level. Therefore, we suggested the National Health Insurance authorities: Before the implement of DRGs, due to the cost gap exist in the different function of hospitals，they will face the different impact of DRGs on the point value under current system ,Bureau of National Health Insurance should be considered and worked out the relevant supplementary measures.