| Summary: | 碩士 === 長榮大學 === 醫務管理學研究所 === 96 === Background: Women’s health issues, whether related to medical care or prevention, have attracted great attention all over the world. In Taiwan, the mortality rate of breast cancer has been higher than cervical cancer since 1999, and ranks the fourth in women cancer mortalities, next to lung cancer, liver cancer, and colon or rectum cancer. The Bureau of National Health Insurance has implemented a Payment-For-Performance pilot project for the care of cervical cancer, pulmonary tuberculosis, diabetes, asthma and breast cancer since October 2001. .
Purpose: The author holds an assumption of the Payment-for-performance System enhances the quality of medical treatment and the control over cost management in institutions. The research question of this study is if the tentative project of breast cancer can enhance the quality and reduce the cost of medical treatment? Meanwhile, this study also investigates and analyses the cost and the effect of medical treatment in this tentative project of breast cancer.
Method: A comparison between an experimental group (a medical center involved in this tentative project of breast cancer) and a control group (a medical center not involved in this tentative project of breast cancer) is conducted by analyses of the cost of medical treatment(characteristics of using medical treatment and important items of medical treatment, such as chemical, radiological, and surgical treatment) and the effect (death rate) in the former year (the year of 2001) and the next year (the year of 2003) of this tentative project being conducted.
Result:From the perspective of the characteristics of using medical treatment, the number of outpatient visits decreases（t=15.15，p=0.000）and the cost does decrease in the experimental groups. At the same time, the control group remains the same in the numbers of either outpatient or inpatient visits. From the perspective of important items of medical treatment, the experimental group prefers radiological treatment（t=-8.536，p=0.000）and the control group prefers chemical treatment（t=-8.536，p=0.000）. From the perspective of the cost of medical treatment, the experimental group spends more in chemical treatment（t=5.172，p=0.000）, and less in radiological treatment（t=-20.67，p=0.000）than the control group does. Two groups do not reveal any difference of the death rate.
Conclusion: The experimental group reveals a decrease of the number of outpatient visits and chemical treatment, but does not reveal a decrease in the cost of medical treatment when comparing before and after participating in this tentative project of breast cancer. The experimental group reveals less cost in the radiological treatment and remains the same in other types of medical treatment when compared to the control group. Also, these two groups show no differences in death rate. Also, it reveals no significant differences between these two groups in terms of the real cost of patients’ medical treatment and the fee application of medical treatment from the Bureau of National Health Insurance.
Breast cancer patients in the experimental group have a higher average of day number for seeking medical treatment before the conduction of this tentative project and than the patients’ in the control group. This may cause a higher cost of medical treatment. A higher average of day number in seeking medical treatment may indicate more severity of patients and more cost in medical treatment. The information about the phases of patients’ breast cancer should be investigated in future studies.
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