A Study of Doctors'' Orders in Case Payment System--The Case of Total Knee Arthroplasty

• Main Authors: Jenn-Huei Renn, 任振輝
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/20070191487773906947

碩士 === 國立陽明大學 === 醫務管理研究所 === 90 === As the proceeding of the National Health Insurance （NHI）, utilization of medical resources and health care expenditure has increased significantly; fee-for-service is believed to be the main cause of these conditions. Therefore, the NHI bureau proposes case payment system and global budget system to solve financial crisis. Case payment system is still an important content while global budget system was applied. Case payment system helps hospitals to define their products. Clinical pathway, induced by case payment, makes health delivery in way of standard operating process possibly. These changes help hospitals to know how to control their cost and standardize quality. To simplify procedures in clinical pathway is a way to reduce cost and improve quality of core service. This study focuses on the case total knee arthroplasty, one of the case-mix of case payment system, of two medical centers. With the data from the chart of medical fee and prescribed orders from NHI’s fee request process, the study wants to find out the orders, which can approach the process of process re-fining. From July 1999 to July 2001, 1,217 cases of total knee arthroplasty were collected from two, A and B, medical centers in Taiwan, whose Orthopaedics surgeon have similar training background. There are 828 cases from A hospital, and 389 cases from B hospital. Mean age of A hospital cases is 71.53±8.28, and of B is 69.32±9.05. Male to female ratio is 46 to 54 in Hospital A cases and 41 to 59 in Hospital B cases. The study results reveal: 1. the items can be omitted including from the standard process including urinalysis, S-GOT , S-GPT and stat urinary catheterization/Foley catheterization, and these items can be prescribed only in suspected cases by history taking or physical examination, 2. item can be changed to the other low cost item and will not reduce the core service quality including general anesthesia, which can be substituted by more cost saving and safer spinal anesthesia or epidural anesthesia, 3. items should be prescribed with caution including bacteria culture , drug sensitivity test, and small specimen biopsy only for special suspected cases, and 4. orders should not be re-prescribed by using previous data in the OPD or previous admission history including routine blood typing and RH(D) typing.