Case-Mix Index and Hospital Gradation

• Main Authors: Tai,Chun-Fang, 戴君芳
• Other Authors: Han,Kuei
• Format: Others
• Language: zh-TW
• Published: 1996
• Online Access: http://ndltd.ncl.edu.tw/handle/35824841791047423160

碩士 === 國立臺灣大學 === 公共衛生學研究所 === 84 === With an effort to reduce growing health care costs, DRGs/PPS has been implemented in U.S. . However, patients cared in hospitals are supposed to suffer from a wide variety of different diseases and conditions, HCFA has developed an indicator(Case-Mix Index; CMI) to recognize the difference of relative costliness of hospitals from the average consuming of resources during case mix. It will reflect the average case-mix for all hospitals to adjust for differences in hospital costs that result from the very differences in the type and mix of cases treated by various hospitals. In order to recognize the case-mix complexity of different hospitals in Taiwan, we tried to apply CMI developed by HCFA and chose one medical center (hospital A) and two regional hospitals (hospital B and C) haphazardly in Taipei city to calculate their CMIs by the data of inpatients(excluding self-paying inpatients) actually from July to December, 1995. We find that CMI for hospital A(1.2210) bigger than the counter parts for hospital B (0.9159) and hospital C (0.8631). It corresponded to original hypothesis: medical center deal with more complicated cases with higher CMI than that for regional hospitals. If the more complicated cases need more intensive medical care, then it could be concluded to that the sequence in medical care ability is: hospital A > hospital B > hospital C. We also used DRGs of three hospitals as" title " and the multiplicity of their relative weight and case numbers as" value " to analyze the value distribution of these three hospitals. We have found the highest 20% values of DRGs of these hospitals having occupied more than 70% of total values in each hospital. It has met Pareto Principle and could be referred to hospital management.