中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/26040

  

The study on the payment system for rehabilitation medicine
 !"#$ % $ &  '(  %  &  ' )*+,-. /0123456789:5; E-mail: [email protected]  3<=> ?@ABCD EFGHIJ K
LMNOPQR2STUVWXY Z6[3\]6J^_KU`abc dGHefIJK
Lg!hZij >klmn opqr JKstuvw   xyzi {p|}~€x‚ƒ„…†‡ˆ‰ oŠU‹V‚ƒŒŽ_~ e‘Uu’“qr  ”•i –p  F ] 6 — ˜ ™ƒ š › ‡ acute careŠ1MQUœžt™ƒ"Ÿ ‡subacuteŠ C¡¢ƒš›1MU £J^‚¤¥¦§x¨©ƒš›i 2ª«p‚R2¬sp­w‚ !…†pIJK
Lp[3\  Abstract

This study develops the proper scheme by referring to the experience of other medical specialist and countries. First part of this study is to explore the difficulties of implementation of Prospective Payment System (PPS) for inpatient medical rehabilitation under NHI by reviewing related paper and to make some advanced advice for reorganizing payment system in the future. Second part of this study is to analysis 997 medical fee of four hospitals (include medical center, rehabilitation

teaching hospital, regional hospital, and quasi medical center) charged by NHI in Taiwan.

The conclusion of this study is describing as below:

1.It is necessary to developing a case-mix system for inpatient rehabilitation before an appropriate PPS for rehabilitation can be developed and implemented.

2.The future trend of developing payment system of inpatient rehabilitation is towards applying to functional independence measurement (FIM) and hospitals be paid according to functional gain.

3.Besides acute care in rehabilitation, it is necessary to provide patients with a optimum continuous medical care by combining sub-acute care and other long-term care.

Keywords: rehabilitation, functional related groups, functional independence measurement, case payment, stroke.
®¯°±²x

³´:µh¶p·¸S¹kMxº »UVO¼½¾¿ÀÁUP+ÂJÍ ÄÅÆǙƒJÈ_¢ƒJ‡9:ÉUÊ 87ŠUËÌU ÍΚ›Ï;Ð

ÑÒ¤'Ój>iÔÕÖÊP×ØW%– &o'GHÙÊÎÚÛV“UÜÝ Þ x^ßËàÚÛáâãäåæU  ç}Í 86 %O 87 %èéÁ 22.92 êë 19.76êUÌQVjì_)x53í îïð²éÁñòóé‡ÚôUÊ 88Šiõö<÷œøùU Çúûƒ xI…
L‡Fee for serviceUFFSŠº_y üƒIJK
L‡Case paymentŠUgVà ýþ ç}xéÁUâPQ
 œÒUPPS  GHŸJ^¼½]6 ç}O¼½]6'½n‡Rosenstein A H. 1991Ši ÇÚGHŸU]6x+ ‡ UÊ 85ŠUâÞ £} xKU†Í]6xJ^àö >Þ p ŸÜÝÞ iPQxU ç} xV P_!U" 1986 %°( 1994 %UMedicare #$gx6O%#X &UéÁ ˜ 87 ê‡Prospective Payment Assessment Commission 1996ŠU '( Ö 1986 %°( 1993 %UMedicare x™ƒ] 6^ß&²n˜ 10êU)FÙ%x ]6ñ*b+,-xéÁ‡Ç 2.9‰

( 7.2‰ŠUËÌUFxç}.Ç 1990%x 1.9 /éÁ( 3.7 /‡Prospective Payment Assessment Commission 1996ŠU` CéÁË0Ug‚1Ë x2
3§#4i>5ù¦}1Mt 6ç78Oš›97U|}S …€p~€x‚ƒ„…:;iÇ  x<ƒ±o=™ƒ 3>UË ÌU?vwoY@Ax ÚÏ ;UC x2
à­wB…x >i ?@ABCD EFGHI JK
LMNOPQR2STUVWX YZ6[3\]6J^_KU`ab cdGHefIJK
Lg!hZi  kl±aI op|}~€x‚ƒ„…†‡ˆ‰ oŠU‹V‚ƒŒŽ_~ e‘Uu’“qr  ”•i {p Ï;C_DÁ"ƒ  E±D™ƒ EU SÁ"ƒ xÂJ‡m[3 \Š—˜™ƒš›‡acute careŠ1M

QUœžt™ƒ"Ÿ‡subacuteŠ  C¡¢ƒš›1MU£J^‚¤¥ ¦§x¨©ƒš›i –p?VFG1HI?6J  ç}pÞ çpKç » ðUqb 1. »ð_J ç}Ö»ð%Låæ ç} UuË_%LM^ßöN ^OPƒ[3\pQOPƒ[3\R çSTiÖ»ð]6'&UÒåæUË Ì?$_UàýV]6'&uW *F]6 ç}éÁ2ªË 0i 2. »ð_Þ çÖ»ð6è RçX_UYZ[Z\Z]UY 6_EF^56UËÌC Þ ç}SiÖ»ð_%_eU `OPƒ[3\^ßç}ãù aƒUbÇcdùaƒ[3\^ ßö“Ö ICUUJ^>SöxEe ›š›Rfx>Þ “ xöi 3. IJK
Lç}ghklUi3 6U`gh¼½Jç}j 80,023 k‡l— 15êmnŠë 110,124 k‡’ lmnŠoUpè
hsg hUœgŽ_ç}qryABs ti WpqrOuv~€‚Œ9w… † xfPy J^<ƒUzm   q r Ô Õ {  ‚ R 2 ¬ s ‡FIM-FRGŠi²y!j>x:Ž|u}P y~ 1Muvf‚R2¬s ‡FRGsŠx$U€‚J^‚ƒŒ xƒ‰„…AB‘UV†‡stˆ !R2xPyG‰i Špvw‹o8¶xŒ[st ÍúŽPQ<÷gqbUõöx   | } D    ~  s t ; ‹ E ‡ Uniform Data System for Medical RehabilitationŠxsti‘uoYÇ P 5’8>A±x¶stU" 1987 %“”•†‡Ù  1Mx]6J ^stU—˜–?x+—5stQUœ˜ ™^ßx‚ƒŒ9wiCš›_8¶ ‹oQÁ"x†‡J^stUf R2xstœ¤‚“žO@ži ópqr JKst

V>Ÿs ¡}x“qrJK st‡KmFIM-FRGŠU—˜g‚ / 0;πU£¢x /0£¤x¥ eOaI¦€‚ /0§…€UÚÛ +p z¨ßpO^ߖhàU©x yªg«¬­UV5§t6xÎÚÛç ñi
®élÖ9

  




 !"#$%&'(

)*+,-./01
23

456789:;<

=>? @A=BCDEFG

)HIJ;KL,-MN

OPQ ROS) :T

U VW

Arnold S, Fama T, Fisher K, Sharda C. Interim report on payment reform for PPS-excluded facilities: congressional report C-92-05: October 1992. Washington, D.C. Prospective Payment Assessment Commission,1992:16.

Bruzko W.: Prospective payment for inpatient rehabilitation under Medicare: an examination of some critical

issues[Abstract]. AHSR&FHSR Annual Meeting Abstract Book. 1996 12:91 Center for Functional Assessment Research,

Uniform Data System for Medical Rehabilitation‡Adult FIMŠ,Version 4.0. Buffalo, NY:State University of New York at Buffalo,1993

Evans RL. Halar EM. Hendricks RD. Lawrence KV. Kirk C. Bishop DS. Effects of prospective payment financing on rehabilitation outcome. International Journal of Rehabilitation Research. 1990 ,13(1):p27-35.

Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD.: Case mix definition by diagnosis related groups. Med Care 1980; 18 suppl:39.

Fetter RB.: DRGs:their design and development. Ann Arbor, MI: Health Administration Press, 1991.

Fries BE, Schneider DP, Foley WJ, Gavazzi M, Burke R, Cornelius E.: Refining a case-mix measure for nursing homes: Resource Utilization Groups‡RUG-IIIŠ. Med Care 1994;23:p668-85.

Harada N, Sofaer S, Kominski G.:Functional status outcomes in rehabilitation. Implications for Prospective Payment. Med Care 1993; 31(4)p345-57

Harada N, Kominski G, Sofaer S.:Development of a resource-based patient classification scheme for rehabilitation. Inquiry 1993;30:p54-63

International Classification of Diseases, 9th Revision, Clinical Modification, 4th ed. Los Angeles: Practice Management Information Corp., 1993.

Katz S, :Studies of illness in the aged. The index of activities of daily living. A standardized measure of biological and sychosocial function. JAMA 1963;185:9149

Leighton Chen et.al: ‡special articaleŠ The effect of Medicare’s payment system for rehabilitation hospitals on length of stay, charges, and total payments. N Engl J Med 1997;337:978-85

Medicare provider reimbursement manual. Part 1. Washington, D.C.: Health Care Financing Administtration, 1994: 30-3,30-53

Pettengill J,Vertrees J.: Rehabilitation and validity in hospital case-mix measurement. Health Care Financing Rev 1982;4(2):101-28

Report and recommendations to the Congress: March 1, 1996. Washington, D.C.: Prospective Payment Assessment Commission, 1996

Stineman MG, Escarce JJ, Goin JE, Hamilton BB, Granger CV, William SV: A case-mix classification for medical rehabilitation. Med Care 1994;32:p366-379

Stineman MG, Hamilton BB, Goin JE, Granger CV, Fiedler RC: Functional gain and length of stay for major rehabilitation impairment categories. Am J Phys Med Rehabil 1996;9:p2-7

Stineman MG. :Case-mix measurement in medical rehabilitation. Arch Med Rehabil, 1995;76:p1163-70

Stineman MG, Granger C, Escarce J, Goin J, Hamilton B, Williams S.: A Prototype Classification System for Medical Rehabilitation: Report to the American Rehabilitation Association. Washington ‡ DC Š American Rehabilitation Association. 1994

Sutton J, De Jong G, Wilkerson D.: Function-based payment model for inpatient medical rehabilitation: an evaluation. Arch Phys Med Rehabil 1996;77:p693-701

Tsuji T, Sonoda S, Domen K, Saiton E, Liu M, Chino N.:ADL structure for stroke patients in Japan based on the functional independence measure. Am J Phys Med Rehabil 1995; 74,p 432-8

James W.: Rehabilitation. THE CONTINUUM OF LONG-TERM CAREAN INTEGRATED SYSTEMS APPROACH., Delmar Publishers 1996:p311-24

 

ˆ‰o :µ‚­w !„…† J ® '" % & '  ð  ð ² @Ù ¯ ã… q° 3 q° ±² q° ³´/2§
 ºµ ƒ­ w @Ù ­w Ö¶šŽ A _ˆ· 1 2 3 4 5 6 7 B _¸ª 1 2 3 4 5 6 7 C _¹º 1 2 3 4 5 6 7 D _»¼½ 1 2 3 4 5 6 7 E _{»¼n¾¿ÀpÁ} 1 2 3 4 5 6 7 F _m 1 2 3 4 5 6 7 ™ÃÄV  G _Åƛ6 1 2 3 4 5 6 7 H _Çț6 1 2 3 4 5 6 7 ! É I _{dpÊpËÊoÌÑ 1 2 3 4 5 6 7} J _Â#oÌÑ 1 2 3 4 5 6 7 K _ºÍoÌÑ 1 2 3 4 5 6 7 Î É L _!Î/ËÊ 1 2 3 4 5 6 7 M _nÏÐ 1 2 3 4 5 6 7 ¬ ­ N _6Ñ 1 2 3 4 5 6 7 O _†ò 1 2 3 4 5 6 7 ·¸$ P _·¸ÒÉ 1 2 3 4 5 6 7 Q _ÑÓ 1 2 3 4 5 6 7 R _ÔÕ 1 2 3 4 5 6 7      !"#$%  &'()*   )*