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Please use this identifier to cite or link to this item: http://ir.ncue.edu.tw/ir/handle/987654321/19056

Title: 以診斷關聯群為基礎的前瞻性支付制度是否有效?
Does Diagnosis Related Groups-based Prospective Reimbursement System Work?
Authors: 江家瑜
Contributors: 企業管理學系
Keywords: the Tw-DRG Reimbursement System;Hospital Performance;Hospital Profitability;Hospital Efficiency;Physician Fee Program;Pay-Performance Sensitivity
診斷關聯群支付制度;醫院績效;醫院獲利能力;醫院效率;醫師獎酬制度;獎酬與績效的敏感性
Date: 2013
Issue Date: 2014-10-01T08:51:30Z
Publisher: 國立台北大學
Abstract: The main purpose of the dissertation is to investigates whether the Taiwan Diagnosis Related Group-based prospective reimbursement system (Tw-DRG) works in Taiwan. This study consists of two independent chapters. Chapter 1 examines whether the Tw-DRG scheme improved hospital performance in a private not-for-profit hospital in Taiwan. This study compares data from the case hospital concerning monthly financial data and related information for 26 departments from 2009 (before the implementation of the system, i.e., the pre-Tw-DRG period) with that from 2010 following the implementation of the system (the Tw-DRG period). This study employs a pre- and post-design with a comparison group study approach. The intervention group consists of departments where more than one case is reimbursed under the Tw-DRG policy and are classified as the Tw-DRG group; and the comparison group consists of departments that do not have any cases reimbursed under the policy and are classified as the non-Tw-DRG group. Departmental operating profitability and efficiency in the case hospital are used to measure hospital performance over the two aforementioned periods. The results find that in contrast to the non-Tw-DRG group, the performance of the Tw-DRG group in the case hospital deteriorated after the introduction of the Tw-DRG program. This study aims to contribute to a better understanding of the economic roles of the Tw-DRG policy. Documenting the relationship between the regulatory intervention and hospital performance has policy implications for health policy officials and healthcare organizations. The findings of this study might also be valuable for health policy officials and healthcare organizations in other countries who are considering the implementation of prospective reimbursement systems.
In Chapter 2, this study examines the effects of a Physician fee (PF) program on a hospital’s performance before and after the implementation of the Tw-DRG scheme. I use a private not-for-profit hospital in Taiwan to investigate the research question. The data sample contains 624 monthly observations of the 26 departments in the case hospital for the period 2009-2010. Of the 26 departments, 18 have implemented the Tw-DRG reimbursement system and are classified as the Tw-DRG group; and the other 8 departments are classified as the non-Tw-DRG group. Since the introduction of the TW-DRG system, the physicians in both groups have been paid under the PF program. The pay-performance sensitivity measure is used to examine the relationship between hospital performance and physicians’ compensation before and after the implementation of the Tw-DRG system. The departments are classified according to their degree of Tw-DRG involvement, and the effects of the PF program on the hospital’s performance are assessed. Overall, the results show that the case hospital’s performance deteriorated after the implementation of the Tw-DRG system. The results imply that conflicts arise between departments that are under the Tw-DRG reimbursement scheme and those that have implemented the PF program. This study also provides evidence that physicians’ behavior affects their clinical performance, especially under a strict cost containment payment policy. Hence, health service researchers and healthcare providers should reexamine incentive mechanisms for physicians that work under similar payment policies.
本論文主要探討在台灣實施以診斷關聯群為基礎的前瞻性支付制度(以下簡稱Tw-DRG制度)是否有效。本論文包含兩章,第一章探討在民國99年開始實施Tw-DRG制度對醫院的績效之影響。本章使用個案醫院做為研究樣本,該個案醫院係屬於財團法人醫院;根據個案醫院所提供實施前一年與實施當年的月資料做研究,將符合研究的26個科別納入驗證相較於沒有實施Tw-DRG制度的科別,是否有實施Tw-DRG制度的科別其績效在實施Tw-DRG制度後有顯著提升。本章使用財務與非財務績效衡量醫院績效。在控制影響醫院績效的因素之後,由第一年初探實施Tw-DRG制度是否影響醫院績效之結果,發現個案醫院無論其財務或非財務績效皆在實施Tw-DRG制度後有降低之情形。
第二章探討醫院的醫師獎酬制度在實施Tw-DRG制度後對醫院績效的影響。本研究採用獎酬與績效的敏感性欲檢視在實施Tw-DRG制度前後,個案醫院的績效與醫師薪酬兩者關係之變化。實證結果發現控制其他相關因素後,若個案醫院的獎酬制度沒有改變,則會使得醫院的績效在實施Tw-DRG制度後變差。主要原因是個案醫院的醫師獎酬制度的設計沒有改變,醫師提供醫療服務的誘因也不會改變,此時,若外在給付環境的改變,個案醫院的醫師獎酬制度是無法同時達成極大化醫師的個人財富和極大化醫院績效之目標,亦無法激勵醫師有效率的運用醫療資源,故本章證明實施Tw-DRG制度後,個案醫院的醫師獎酬制度是需要被重新調整的。
Relation: 博士; 國立台北大學會計學系
Appears in Collections:[企業管理學系] 專書

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