影響Tw-DRGs 4.0敗血症醫療費用之因素－以某區域醫院為例

In order to enhance payment reform, National Health Insurance (NHI) Administration has phased in the 3rd DRGs. This study aims at exploring the influential factors of sepsis patients' payments at a regional hospital by Tw-DRGs 4.0. In this study we collected the information of 1,035 sepsis inpatients' medical expenses from a regional hospital in Northern Taiwan. This retrospective study was carried out using secondary data for its statistic analysis. Results of Linear Multiple Regression indicated that age (p<0.013), multiple organ failure, length of hospital stay, and discharge by death (p<0.001) all had significant effects on medical expenses. We found sepsis patients diagnosed with two or more organ failures were reimbursed with much higher NHI payments. Therefore, the NHI Administration should review the disease severity and reimburse more appropriate payments by introducing new DRGs. For achieving better sustainability, physicians should document the patient's conditions in more detail, coders give correct DRGs, and hospitals better control the length of hospital stay and medical expenses in order to improve the balance between quality of care and permanent cost containment.