| Summary: | 碩士 === 國立中山大學 === 資訊管理學系研究所 === 98 === Since the systems of health insurance of the whole people were run in March of the 84th year of the Republic of China, it is very near to offer medical treatment to the best patient in the whole world, the highly free right to choose of seeking medical advice, and high-quality medical care. But cause the expense expenditure of the hospital to rise continuously, is strong in protecting the office as because in conformity with the financial situation, pursue a lot of financial retrenchment policies successively, cause uncertainty and complexity of the medical industry''s environment. Especially pay the system so far the total value of the hospital, decline in the development in economy of the whole world depressedly, domestic aging of population, unemployment increase, medical resources are insufficient day by day and strong in assuaring the financial affairs are left pressingly, the central health insurance bureau is paid the system and controls the cost, adjust and pay the standard progressively, towards pay, standardize while being single, so reform pay medical the intersection of institutes and way pay system for TW-DRGSs '' diagnose related group in hospital '' stage by stage year by year from January of 1999.
Made in Singapore after setting out on a journey, future so long as medical resource more close part will be sorted out into the same class, in accordance with kinds of Diseases, operation, age, gender, amalgamate condition classification such as disease, divide into groups according to the weight grade of the condition, pay by norm, is lower than lower limit, will adopt and verify that declare the way, that is to say '' pay the system with severity and reward ''. The government implements the policy purpose of '' TW-DRGSs '', except the efficiency of serving for raising medical treatment, reduce the waste, also can improve patient, look after quality and curative effect, let the intersection of hospital and the intersection of cost and optimization, but the implementation of DRG will cause the suitable impact of the hospital, may aggravate looking after and financial responsibility and risk of the medical organization.
But hospital attribute( Set objectives, the intersection of role and localization, organization and the intersection of power and responsibility and structure,etc.) Different, the hospital faces being strong in assuaring that it and because will be different to pay the financial pressure that the system changes in conformity with ways, except army''s hospital in the country shoulders the country and looks after soldier''s healthy policy responsibility, pay attention to managing the performance even more. So because should be strong in assuaring that it will be different to pay measure and efficiency that the system''s changing takes and lowers costs to some extent, and these differences will react on the manifestation of financial performance indicators such as its medical care amount, income and interests,etc.. Satisfied how to promote the financial performance of the hospital, give consideration to operations objective, medical care quality and patient of the hospital at the same time, key factor that will be managed continuously forever for the hospital.
Until '' diagnose related group in hospital '', first serious the intersection of case and clinical route standardize, influence clinical the intersection of route and standardization make, act as, in hospital number for the first time, so this research institute builds the systematic dynamics model constructed, the ones that chose the first stage to implement 155 items of TW-DRGSs were in hospital in days, the hospital TW-DRGSs case number, take bed rate and satisfaction in hospital etc., these influence each other the simulation of the relation value adopts Table function to imitate. And Table function which this research institute puts forward passes the true data in often operation course on ordinary days of case hospital, observe and experience judgement or relevant literature consult materials of income, performance its weigh the intersection of indicator and system can represent the intersection of country and the intersection of army and the intersection of hospital and case only, can''t prove why the other scale hospitals are appropriate; And this research is paid and imitated according to the systematic way of case hospital alone, as system way may present different results not simultaneously.
Expect to give the case hospital some suggestions in managing, managing and is made with the clinical route through this research, the colleagues of staff of different levels work satisfiedly in safeguarding patient''s whole rights and interests, courtyard, promote the quality of medical care, the purpose of this research:
(1)Make use of system of macroscopic think way, canvass the intersection of case and hospital, implement, good for, protect TW-DRGSs at the system, the influence that the management in hospital stays runs to the case hospital for a long time, and can assist the case hospital to find the optimum management effect.
(2)Set up systematic dynamics way, imitate the intersection of case and hospital, divide into annual to implement, good for, protect TW-DRGSs, in hospital management of day to the intersection of hospital and revenue and expenditure, medical behavior and influence to cure the desease relation at the system stage by stage.
The concrete suggestion of this research is as follows:
(1) Control and manage number in hospital, increase the turnover rate of the sick bed
(2) Set up all kinds of disease clinical guiding or clinical routes
(3) Improve the hospitalization cost and declare benefit
(4) Research of project development at one''s own expense
|
|---|
