The Impacts of Fixed Hospital Budget on Medical Service: A Study of Distal Ureteral Stone Surgery

• Main Authors: Jo-Yu, Kao, 高若瑜
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/95804033274636985887

碩士 === 國立陽明大學 === 醫務管理研究所 === 96 === The Bureau of National Health Insurance has implemented the Excel Project, which lasted half year since July 2004. The study is for researching the influence of the policy on the medical services provided by medical centers, and analyzing the change of attributes and behaviors of both hospitals and physicians. The study takes both a half year before and after July 2004 respectively as the reference period, and takes ureteral physicians who perform Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopy (URSL) as researching targets. The study analyzes the registration data of their inpatient and outpatient in a recalling way, and further performs descriptive statistics, paired t-test, according to the changes and differences of the ureteral operation service, performed by ureteral physicians in medical centers, before and after the project was implemented. The study discovered the attributes of hospitals, such as ownership, the branch where the hospitals belong , whether the hospitals join the Excel project, the sex and the age of physicians, that the significant differences inhabited the average number of performing times of the operation performed by each physician. In the “aspect of attribute of hospital’s physicians”, there are significant decrease over medical centers before and after the Excel project was implemented. There are significant decrease over the “middle-region branch” before and after the Excel Project was implemented. Before and after the Excel Project was implemented, “Legal Foundation Medical Center”, “the Taipei-Region Branch to which the hospitals belong”, are significant increased on the total number of patients had ESWL operation by each physician . The proportion of number of patients had ESWL operation by each physician were significant decreased in Taipei-Region Branch, but there is no significant on the URSL:ESWL operation by each physician to number of patients had all operations by each physician. There are significant decreased on both the proportion of the number of ESWL patient inpatient and the number of ESWL patient outpatient by each physician in the Public Medical Center. There are significant differences before and after the operation. by each physician. There are no significant difference between the number of Calculus of ureter inpatient patient and outpatient patients by each physician before and after the project wasimplemented.