Academic literature on the topic 'Prostatectomie totale'

碩士
高雄醫學大學
公共衛生學研究所
89
Background and Objectives The major of this study was to evaluate the National Health Insurance impact of case payment system on prostatectomy and total hip replacement (THR) inpatients. Specifically, it was to examine whether there was any difference in patients’ length of stay, total inpatient care expenses, and their medication fee, items, and contents. Methods and Materials The data source was derived from inpatient claim files of Kao-Ping Branch, the Bureau of National Health Insurance. The study time period started from October 1997 to June 2000, that is, 42 months in total. As a whole, 1,649 prostatectomy patients and 1,258 THR patients were entered into analyses. Descriptive analysis and inference analysis were conducted by using SPSS for windows 8.0. Results The study findings were summarized condensed as follows. After the implementation of case payment system, the length of stay of prostatectomy patients decreased 1.01 days on average; total inpatient care expenses increased N.T. 1,542 dollars; and the medicine fee increased N.T. 565 dollars. With respect to the number of medication item, there was no significant difference in prostatectomy patients before and after case payment system. In considering medication contents, the use of cephalosporins antibiotics, nonsteoidal anti-inflammatory agents, replacement preparations, caloric agents and diuretics was increased. However, the use of aminoglycosides antibiotics, miscellaneous analgesics, and antipyretics was decreased for prostatectomy patients. For THR patients, their length of stay on average was 0.33 day lower after case payment system; total inpatient care expenses decreased N.T. 9,812 dollars; and the medication medicine fee increased N.T. 205 dollars. After case payment system, the medication of THR patients reduced 2 items on average. However, the use of cephalosporins antibiotics, nonsterodal anti-inflammatory agents, skeletal muscle relaxants was increased; meanwhile, the use of aminolycosides, the opium resembles the medicine, and replacement preparations was decreased. In terms of readmission rate of post-operational 14 days and of post-operational 1 month, there was no inter-organizational outcome difference among hospitals. In a sense, the medication portfolio of medical centers had lower mediation fee on average, which could serve as a benchmarker for other hospitals. Discussion In conclusion, case payment system actually had shortened length of stay of inpatients; however, the medicine expenditures increased. Consequent prescribing behavior intended to use more antibiotics and nonsteroidal anti-inflammatory agents, which needs future research to further evaluate the effects of case payment system on hospital medication utilization and management.