台灣全髖及全膝關節置換術醫療費用分析--論病例計酬後

健保局自1997年對人工全髖關節置換術與人工全膝關節置換術實施論病例計酬以來，整體醫療費用逐漸下降，下降的是哪些醫療項目呢? 本研究是透過國家衛生研究院健保資料庫擷取人工全髖關節置換術與人工全膝關節置換術住院資料進行分析，以了解論病例計酬實施十年後，醫療費用的變化。我們擷取2000-2001年及2010-2011年兩個時間的人工全髖關節置換術與人工全膝關節置換術住院資料，經分析比較發現，十年間整體醫療費用下降，住院天數下降，藥費下降，但是檢查檢驗費及放射線檢查費並沒有顯著改變，麻醉費用也沒有改變，顯示對病人狀況的掌握及照顧並沒有受到影響。手術費與特殊材料費是由健保局律定的金額，因此也沒有改變。論病例計酬實施後十年間的人工全髖關節置換術與人工全膝關節置換術案件數增加，顯示民眾對這兩個手術的接受度提高，醫界也藉此收益增加，健保局也達到醫療費用下降的目的。

From 1997, the National Health Insurance Bureau (NHIB) started case payment of Disease-Related Group (DRG) for total hip arthroplasty and total knee arthroplasty. The total medical costs showed a declining trend. However, which items of medical service became less? The study used NHIB database to obtain inpatient data of total hip arthroplasty and total knee arthroplasty for analysis of medical costs. We retrieved inpatient data of total hip arthroplasty and total knee arthroplasty from 2000-2001 and 2010-2011. After analyzing, total medical costs showed decreased and also length of stay, pharmacy fees. But the laboratory tests fees and radiologic examinations fees and anesthesia fees were not changed. It meant the monitoring of patients’ condition was not influenced after DRG implement. The charge for surgery and costs of prosthesis were regulated by NHI, so these fees were not changed. After implement of DRG by ten years, the numbers of total hip arthroplasty and total knee arthroplasty showed increased. It meant these surgeries were more popular than before. The benefits for hospital might be increased due to increased numbers. The total medical costs were also decreased as NHIB expected.