影響自然生產醫療費用之相關因素研究--以某軍方教學醫院為例

　　　　　全民健保於84年3月1日起實施，且隨即在當年7月1日要求各級醫院之「自然生產」個案，須以「論病例計酬」方式申報，此舉顯示健保局嘗試將醫療費用支付方式，從原先之「論量計酬」改變為「論件計酬」前瞻性付費之企圖，當醫療給付不再是以往的「多做多得」時，對產科醫師、醫務管理及費用申報單位均有相當大的衝擊。醫院如何在控制醫療支出下，提供適當的服務品質，是一大挑戰。本研究收集某教學醫院產科84年5月至85年4月自然生產555名產婦之費用申報資料，並有以下發現：(1)在不同身份別產婦住院費用及住院日數之比較上，軍眷均高於健保，且達統計上之 顯著意義，但自84年12月以後已有明顯下降。(2)產婦之住院費用及住院天數會受年齡影響，且以40歲以上產婦之平均值最高。(3)某些醫師會因產婦身份不同而有診療行為之差異。(4)住院費用之主要影響因素為：住院天數、代號為4、6、9、15之醫師，其解釋能力R square值為0.6092。(5)住院費用高於「論病例計酬」支付金額之原因與產婦之診斷、住院天數、使用無痛分娩、特殊檢查及用藥等變項有關。 　　　　　The National Health Insurance(NHI) was implemented in Taiwan on March 1,1995. The Bureau of NHI later requested all hospitals' normal deliveries be paid by case payment afetr July 1,1995. This shows that the Bureau of NHI wants to change the "Fee for Service" payment system to the Prospective Payment System(PPS). Maintaining quality of care with a set cost will be a challenge of obstetricians and hospital administrators. We collected and analyzed the expenses of 555 wowen who delivered babies at a mi litary teaching hospital from May, 1995 to April,1996, and found: (1)Military dependents total expense were higher and length of stay(LOS) was longer than NHI insured. (2)The woman's age affects the total expenses and LOS. (3)Some physicians' medical behavior was influencd by the woman's identity. (4)According to the multiple regression that LOS, Doctor.4, Doctor.6, Doctor.9, Doctor.15 are important factors that effect total expenses. (5)The reasons that the woman' s expenses are higher than the NHI cas e payment were attributed to diagnoses, LOS, epidural anesthesia, special exams and drugs.