碩士 / 中國醫藥學院 / 醫務管理研究所 / 87 / To develop a more suitable payment system for inpatient medical rehabilitation in
Taiwan for controling the increasing payments to rehabilitation facilities under NHI
(National Health Insurance) is a quite hard-work for legislative and administrator. Many
foreign study tried to find out the predictors of resource utilization but the aspect of
these studies in Taiwan are still absent. This study tries to explore the suitable scheme
by referring to the experience of any other medical specialist and countries.
First part of this study is to explore the difficults of implementation of Prospective
Payment System (PPS) for inpatient medical rehabilitation under NHI by reviewing
related paper and to make some advanced advices for reorganizing payment system in
the future. Second part of this study is to analysis 997 medical fee of four hospitals
(include medical center, rehabilitation teaching hospital, regional hospital, and quasi
medical center) charged by NHI in Taiwan.
The conclusion of this study is describing as below:
1. It is necessary to developing a case-mix system for inpatient rehabilitation before an
appropriate PPS for rehabilitation can be developed and implemented.
2. The future trend of developing payment system of inpatient rehabilitation is towards
applying to functional independence measurement (FIM) and hospitals be paid
according to functional gain.
3. Besides acute care in rehabilitation, it is necessary to provide patients with a optimum
continuous medical care by combining subacute care and other long-term care.
This study also analysis total medical fee, physical therapy fee, and drug fee of
stroke patients by using multiple regression. The results is that:
1. Since older patients have higher prevalence of cerebral infarce (CI) and the medical
fee of CI is less, the increase in expected total medical fee is increasing by
independent variable--age. The total medical fee is increasing by length of stay (LOS)
significantly.
2. Rehabilitation hospital has higher physical therapy fee than others. The physical
therapy fee of CI is higher than cerebral hemorrhage (CH), which is due to clinical
CH patients always serious and referral from ICU.
3. Clinical CH has more complications and comobidities, i.e. hypertension, diabetes etc.
This study found that drug fee of CH is also higher than CI.
This study also tried to calculate the total medical fee of inpatient rehabilitation,
which can be the references before NHI negotiate the payment rates with hospitals.
| Identifer | oai:union.ndltd.org:TW/087CMCH0528008 |
| Date | January 1999 |
| Creators | Darren Liu, 劉大任 |
| Contributors | Pai Jar-Yuan, 白佳原 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 127 |
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