醫療服務市場競爭程度對住院醫療品質之影響—以急性心肌梗塞為 例
Influences of Medical Service Market Competition on Quality of Inpatient Medical Care－A Case Study of Acute Myocardial Infarction
中文摘要
良好的競爭應有助於醫院的技術成長及醫療品質改善，並增進病患之福祉。本研究旨在探討市 場競爭程度對急性心肌梗塞住院病患之醫療品質的影響，研究發現盼能對於提昇醫療品質有所 助益。
本研究採用2000 年至 2005 年的全民健康保險研究資料庫之住院醫療費用清單明細檔，
以ICD-9-CM 主診斷為 410 之急性心肌梗塞住院病患就醫醫院為研究對象，探討市場競爭程度、
醫院特質、病患組成特質對於急性心肌梗塞住院病患的醫療品質之影響。
本研究以住院期間死亡率、出院後14 日及 30 日內再住院率做為品質指標，市場競爭程度 則採用賀芬達指數，以16 個醫療區(不包含外島地區)做為各醫院的市場範圍，並以住院人日數 做為市場佔有率的計算單位。控制變項則包括醫院權屬別、層級別及服務量，以及該醫院治療之 病患的年齡、性別及合併症程度組成比率。在統計方法方面，本研究以廣義估計方程式分析市場 競爭程度對急性心肌梗塞住院病患的醫療品質之影響。
本研究的重要研究結論如下：
1.市場競爭程度較低的醫療區，其急性心肌梗塞住院病患之死亡率較低，但再住院率較高。
2.地區醫院及服務量較低之醫院，其急性心肌梗塞住院病患之死亡率及再住院率較高。
3.公立醫院的急性心肌梗塞住院病患之死亡率較私立醫院高。
依據本研究之研究發現，茲提出以下幾點建議：(一)對醫院：從提升照護品質，並建立品 牌行銷，以吸引病患前來就診。(二)對後續研究者：從臨床資料探究到院前已死亡的病患，其延 遲就醫的原因為何，以及疾病表現型態等議題。
英文摘要
Competitions can be stimulants for hospitals to have their medical techniques grown more mature and improve quality of healthcare. This research was focused on the medical quality among acute myocardial infarction(AMI) inpatients in relation to the market competition.
Using the files of inpatient expenditures by admissions and registry for contracted medical facilities from the National Health Insurance Research Database(NHIRD) during 2000-2005, this research identified AMI inpatients by a principal diagnosis (ICD-9-CM codes 410). This study discussed the influence of the market competition, hospital characteristics and patient characteristics on AMI inpatients’ medical quality.
The quality indicators were consisted of in-hospital mortality, readmission within 14 days and readmission within 30 days. The definition of hospital market was the 16
medical regions in Taiwan area. This study used the Herfindahl-Hirschman Index (HHI) to measure competitions among hospitals. Control variables included hospital characteristics(ownership, accreditation levels and service volumes) and patient characteristics(age, sex and complications). Cochran-Armitage trend test and
Generalized Estimating Equation were employed to analyze the relationship between the market competition and AMI inpatients’ medical quality.
The research results were summed up as follows:
1.The lower competition area had lower mortality rate and higher readmission rate.
2.Community hospitals and lower volumes hospitals have higher mortality rate and higher readmission rate.
3.Public hospitals’ mortality rate was higher than private hospitals.
