UM E-Theses Collection (澳門大學電子學位論文庫)

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English Abstract

1.2.1Purpose Medical spending has become residents following the family food, education expenses, expenses, the third largest consumer after. Can guarantee high medical value for the development and continuous improvement of health care quality, improve health care efficiency, but also to control medical costs, reduce medical costs the way, as government, medical institutions and the common goal of health insurance. Will affect the health of payment for medical services side of medical practices, and cost control, equity-oriented or constraints generated significant role. According to service our existing pay is increased to stimulate one of the major medical expenses, medical insurance has become an obstacle tothe healthy development of the bottleneck. Correspondingly, the payment of a single disease to promote improvement in the quality of medical services, preparation of a reasonable and effective use of health resources, to maintain the legitimate rights and interests of both doctors and patients. In this study, a large South Hospital in 2003 and 2009 the top three a total of 156,896 cases of patient data, through a series of statistical filtering, hoping to find a group for single-scale fees disease disease, further analysis of impact of these diseases kind of treatment of the major factors to improve the hospital's social and economic benefits, enhance medical quality management and the administrative department of the uniform standard single disease provide a reference. 1.2.2Materials and methods A retrospective review of research methods in a large collection of top three hospitals of the South from 2003 to 2009 156,896 cases of patients discharged from the basic information in a database and excel in proofreading, using statistical software on the above information SPSS13.0 disease classification according to descriptive analysis and screening, the screening cost of treatment based on linear multiple regression model, the total cost of different factors on the impact and control measures. 1.2.3Result 19 selected single disease may be suitable for the implementation of fixed fees diseases were chronic sinusitis, and cystic nodular goiter, hand, foot and mouth disease, pterygium, chronic tonsillitis, senile cataract, uterine smooth muscle tumor, vocal cord polyps, inguinal hernia (unilateral), measles, acute purulent tonsillitis, vertebrobasilar artery insufficiency, acute appendicitis, mixed hemorrhoid, deviation of nasal septum, acute tonsillitis, transient cerebral ischemia, hydronephrosis , accompanied by obstruction of renal and ureteral stones, gallbladder stones with chronic cholecystitis. By linear multiple regression model, found that more than 19 diseases are more common, age, length of stay, drugs constitute a ratio of three factors, all of which are correlated with the total cost. However, gender, payment, admissions, admission diagnosis and discharge diagnosis and prognosis of whether the factors such as differences with the disease's impact on the total cost are quite different. 1.2.4Conclusion The more old patient treatment costs over budget more likely, to the single-disease scale fees, hospitals should strictly control the length of stay, while efforts to reduce the total cost of the part of Chinese medicine costs, fees and charges can be appropriate proportion of medical services. A disease-specific single disease fixed fee policy, in order to control the cost of treatment, gender, payment, admissions, admission diagnosis and discharge diagnosis and prognosis of whether such factors should be considered based on the actual situation and importance . 1.2.5 Keywords Pay scale of single disease;Disease screening;Treatment costs; Factors

Chinese Abstract

1.1.1 目的 醫藥衛生消費支出己經成為我國居民繼家庭食品、教育支出後的第三大消費。尋 求既能保證醫學價高新技術的發展並持續改進醫療品質、提高醫療工作效率,又能控 制醫療成本、降低醫療費用的途徑,成為政府、醫療機構和醫療保險機構的共同目標。 衛生支付方式會影響到醫療服務供方的醫療行為,並對費用控制、公平產生明顯的導 向或制約作用。我國現行的按服務專案付費是刺激醫療費用上升的主要原因之一,已 成為阻礙醫療保險事業健康發展的瓶頸。與之相對應的單病種付費的研究旨在促進醫 療服務品質的提高,合理配製和有效利用衛生資源,維護醫患雙方合法權益。本研究 以南方某大型三甲醫院 2003 到 2009 年共 156896 例住院病人資料為基礎,通過一系 列的統計學篩選,希望找出一批適合實行單病種定額收費的病種,進一步分析影響這些病種治療費用的主要因素,為提高醫院的社會經濟效益、加強醫院醫療品質管制以 及行政部門制定單病種統一標準提供參考依據。 1.1.2 材料與方法 採用回顧性調查研究的方法收集南方某大型三甲醫院 2003 至 2009 年 156896 例 出院病人的基本資訊資料,在 excel 中建立資料庫及校對,用 SPSS13.0 統計軟體對 以上資料按病種分類進行描述性分析及篩選,在篩選的基礎上建立治療費用的線性多 元逐步回歸模型,探討各因素對總費用的影響及控制對策。 1.1.3 結果 篩選出 19 個可能適合實行單病種定額收費的病種,分別為慢性鼻竇炎、結節性 甲狀腺腫並囊性變、手足口病、翼狀胬肉、慢性扁桃體炎、老年性白內障、子宮平滑 肌瘤、聲帶息肉、腹股溝斜疝(單側)、麻疹、急性化膿性扁桃腺炎、椎基底動脈供 血不足、急性闌尾炎、混合痔、鼻中隔彎曲、急性扁桃體炎、短暫性腦缺血、腎盂積 水,伴有腎和輸尿管結石梗阻、膽囊結石伴慢性膽囊炎。通過建立線性多元逐步回歸 模型,發現對以上 19 個病種影響較為普遍的是年齡、住院天數、藥費構成比是三個 因素,三者都與總費用呈正相關。而性別,支付方式,入院情況,入院診斷與出院診 斷是否符合及轉歸等影響因素隨病種的不同對總費用的影響程度存在較大差異。 1.1.4 結論 越是高齡的患者治療費用超預算的可能性就越大,為了實行單病種定額收費,醫 院必須嚴格控制住院天數,同時努力降低總費用中藥費的部分,可以適當提高醫療服 務收費的比重。針對具體某個病種的單病種定額收費的政策制定,為了控制治療成本,性別,支付方式,入院情況,入院診斷與出院診斷是否符合及轉歸等影響因素應該根 據實際情況加以考慮和重視。 1.1.5 中文關鍵字 單病種定額付費、病種篩選、治療費用、影響因素

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Institute of Chinese Medical Sciences




Diagnosis related groups


Hospitals -- Prospective payment

醫院 -- 預期款項

Hospital care -- Cost control

醫院護理 -- 成本控制

Medical care, Cost of




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