A Study of Surveillance Mechanism of Medical Care Expenses –An Example of Single Vessel Percutaneous Transluminal Coronary Angioplasty Surgery

• Main Authors: Meng-Hsien Chuang, 莊孟嫻
• Other Authors: Wen-Hsiang Wu
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/96kmy3

碩士 === 元培科技大學 === 健康產業管理研究所 === 100 === The Taiwan Diagnosis Related Groups (Tw-DRGs) system brought into force in 2010 was intended for controlling constantly increased medical care expenses. Under this system, the medical providers considering more profits but fewer costs, however, might curtail services and Length of Stay (LOS) in connection with patients or reject profitless patients who were driven to medical outcasts. These phenomena downgrade medical quality and impair fairness and accessibility of seeking medical advices. In this study, we construct a surveillance mechanism for medical care expenses related to single-vessel Percutaneous Transluminal Coronary Angioplasty (PTCA) in order to make the Bureau of National Health Insurance (NHI) monitor medical providers’ medical care expenses within or unusual profitable range under the Tw-DRGs system. It is possible that medical providers which are keen to profits have actions detrimental to patients’ rights in the case of medical care expenses exceeding the profitable range. Based on four medical centers selected from the “National Health Insurance Research Database” for case studies, we take data of medical care expenses regarding single-vessel PTCA from 2009 to 2010 and inpatients over 17 years old as our subjects, separating the prospective payment into six segments, and constructing a surveillance mechanism for medical care expenses as one method assisting NHI to monitor medical care expenses.