中央健康保險局中區業務組與中區醫院代表聯繫會 第 38 次會議

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中中中中中中中中中中中中中中中中中中中中 中中 中 38 中中中 中中中中 101 中 12 中 4 中 1

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中央健康保險局中區業務組與中區醫院代表聯繫會 第 38 次會議. 醫療費用一科 101 年 12 月 4 日. 大 綱. 報告案一:中區醫院醫療費用申報概況 報告案二: 101 年第 1-2 季醫院總額管理方案 執行成果及檢討 報告案三: 102 年醫院總額管理方案規劃 報告案四:專案報告 報告案五:轉請配合事項. 中區醫院醫療費用申報概況. 101 年第 2 季醫院總額點值. 101 年第 3 季 醫療費用點數 申報概況. 101 年第 3 季門住診 藥費 申報概況. 101 年第 3 季 特定項目藥費 申報概況. - PowerPoint PPT Presentation

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  • 38 101124

    *

  • *1011-2 102

  • *

  • 1012*

    1010.8305 0.9202 0.8751 0.8875 0.9334 0.9166 0.8806 10.9097 0.9391 0.9255 0.9334 0.9549 0.9432 0.9278 1010.8723 0.9495 0.8876 0.9181 0.9320 0.8673 0.8980 20.9282 0.9508 0.9314 0.9473 0.9537 0.9201 0.9382

  • 1013*

    ()4016358976053400342668252064153235969480854718026 ()8.93%2.59%5.84%2.92%-0.53%1.16%-0.94%1.94%0.27%4.48%1.20%2.90%

  • 1013

    *

    ()2002547254912203931614698145844392010865006 ()8.88%-0.16%6.80%-1.24%-5.71%-2.36%-7.12%1.54%-5.74%2.47%-2.03%1.46%

  • 1013

    *

    6000 ()27193080()7631893356 28,381 9,746 1,090 () 11.51%7.88%3.36%18.38%3.59%-3.05%6.16%-3.98%-6.20%

    #*

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  • 1013

    *

    ()1579124928281568121927878355691404398230377020 ()6.18%1.95%4.27%3.26%0.53%2.05%-0.41%3.94%1.31%3.59%1.74%2.78%

  • *1011_CTMRI

    MRI3090CTMRI ()CT3090CTMRI ()(DA_980)(DA_981)(DA_982)(DA_983)30903090309030903.04%7.21%2.36%5.59%6.37%11.74%4.94%9.47%1.96%4.67%1.32%3.31%5.76%9.82%3.88%7.21%3.85%7.24%2.95%5.46%6.72%11.70%4.69%8.71%2.17%4.96%1.56%3.64%4.29%9.06%3.07%7.05%2.08%5.43%1.34%3.76%5.67%10.39%3.01%6.73%

  • *()

    2010Q3 2010Q4 2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 850086158444887390739063891593259480 837283588197852784458580831786908547 168721697416641174001751917643172321801518026

  • *

    2010Q3 2010Q4 2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 () 511650905042526252675251530654905372 1,6611,6931,6751,6861,7231,7261,6801,6991,765 711712677717730728717744741 55.2856.156.6356.5457.5756.7454.5955.3557.12

  • *

    2010Q3 2010Q4 2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 ()16615916216516716416316616450,41852,56350,74651,71150,65052,16551,08152,27452,1645,1165,1735,2565,2295,2185,2805,3125,2555,2949.8610.169.669.899.719.889.629.959.85

  • 1011-2*

  • *

    101Q2101Q1101Q2101Q1101Q284107106107106586560898469%61%57%83%79% ()-1470 -5490 -6980 -330 -490

  • 1012

    ()*

    3.49%3.71%0.21%2.99%-3.30%-4.57% 4.19%5.17%0.93%2.33%-1.52%-2.43% 3.49%5.09%1.54%3.13%-0.67%-2.13%

  • 1012

    ()*

    -0.80%-1.40%-0.60%0.11%-4.57%-3.46%0.56%-1.16% -1.71%-1.51%0.21%1.08%-5.78%-5.24%0.77%-0.56% 0.86%1.95%1.08%1.48%-1.60%-2.12%0.55%0.53%

  • *()

    101Q1101Q2900130030000 26001200600000

  • *

    101Q1101Q2 101Q1101Q2 25% 323130%29% 25%~49% 373735%35% 50%~74% 352733%25% 75% 3113%10% 107106100%100%

    () 930010800

  • *

    4.18%3.79%()3890030800

    101Q1101Q2101Q1101Q20%584428.70%28.20%10%177.00%30%270.60%3.20%50%335.40%6.40%70%250.30%1.40%100%423065.10%53.80%107106100%100%

  • 102101

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  • 102*

  • _(1/4)*

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  • 3110%15%()*_(3/4)

  • _(4/4)*6000() 12

    10111 (1012)

  • *_(1)102(1/3) 10232()

  • (RCC)ICU24%20%3%1%56%60%2%2

    _(1)102(2/3)*

  • (RCW) _1%__

    _(1)102(3/3)*

  • _(2)*9913126000(001) () _ 3101*(1+101) 101*(1+101 ) _ 1101+ 101 _ (i/i)*0.4+(i/i)*0.6

  • *_

    101510171015

  • *14(TW-DRGs V3.2)3(TW-DRGs V3.2)30CT MRI)

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  • _(1/3)*

  • _(2/3)*101(5)101(5) 101()

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  • 0.94102*

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  • 1004*

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  • 18020

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  • 101204133183441001291,8092,036100721791

    1011~9*

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  • 37029B(XCTMRI)

    37029B*

  • 33070~33072B 33070~33072B*

  • 261()

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  • Nimetazepam Flunitrazepam Zolpidem3-VPN101111VPN(1/3)*

  • 10111~1022390%76

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  • 101.09.13 1010051715101.09.13 1010051720101111019101*

  • *

    02006K() 310 353 43 02007A 290 333 43 02008B 257 300 43 57114C 2,000 3,000 1,00057115C 3,500 4,000 500 57110C 22 150 128 57119B 127 200 73 80416B 17,134 19,929 2,795 80425C 17,134 20,789 3,655

  • =9 (30%53%)DRG11(1012)

    *

  • (Tw-DRGs)(SPR)RW101.10.1()37,34537,726381(SPR)(35,46335,79333088.52.5*

  • **

  • 1/5*

  • AB,DRGDRG

    2/5

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  • 39

    3/5

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  • 21 4/5

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    5/5

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  • http://www.nhi.gov.tw///6http://www.nhi.gov.tw///() 45

    (1/2)

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  • http://www.nhi.gov.tw///(101.11.23) 1 2 3

    (2/2)

    *

  • Tw-DRG*

  • DRGDRG

    *

  • DRG

    **

  • *

    1DRG1-991~3840 958 714 1,011 12.62% 685 594 1,044 1001~3662 846 477 704 -30.42% 450 580 807 1011~3602 699 464 712 1.24% 412 563 627 1622 728 473 746 -0.12% 397 587 585 2607 703 459 714 2.95% 419 580 638 3580 667 459 680 0.78% 419 522 655

    1DRG-991~34.18 4.20 4.16 4.00 -4.13% 4.02 4.47 4.41 1001~34.17 4.22 4.15 3.96 -1.07% 4.00 4.44 4.35 1011~34.13 4.19 4.11 3.90 -1.59% 4.02 4.38 4.27 14.13 4.20 4.12 3.93 -1.26% 3.98 4.36 4.19 24.15 4.21 4.10 3.91 -1.97% 4.05 4.41 4.33 34.11 4.17 4.10 3.86 -1.53% 4.04 4.36 4.28

  • 1011~3DRG(3.90)(4.13)DRG1(712)(602)DRG101Tw-DRGsDRGTw-DRGsDRG*

  • (101116)**

  • 10211671024(116)

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  • 312

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  • 14(3)710(4)37(22)573(92)90(23)

    *

  • (8)23*

  • *

    *************************99Q2*99Q2*99Q2************