24卷6期

• Link 綜論 Review Article
• 回顧社區健康介入計畫：以預防心血管疾病為例A Review of community-based Intervention Programs: Heart Health Projects as Examples
• 林宜平
  Yi-Ping Lin
• 社區健康 ； 疾病預防 ； 心血管疾病
  community health ; disease prevention ; cardiovascular disease
• 本文以預防心血管疾病為例，回顧歐美等國的大型社區健康介入計畫，探討此類計畫缺乏長期成效的可能原因，並討論其研究設計與測量指標，最後則小結社區健康介入計畫未來的研究取向。歐美等國的社區心血管疾病預防計畫，多半由研究機構設計與執行，然而幾個著名的大型社區研究計畫，長期追蹤的結果都發現，介入社區的各項健康指標雖然大有改善，但是對照社區也有同樣的變化，二者在統計上並無顯著差異。本文由這類大型介入計畫的研究設計與其背後的社會變遷，探討計畫缺乏成效的可能原因，並進一步討論美國式量化研究的缺失，比較健康照護體系與社區的異同，及介紹社區層次的健康指標。作者以歐美等國的社區心血管疾病的預防計畫為例，建議未來社區健康介入研究，除致力於個人行為改變外，應同時考慮環境與政策改變；在方法學上質性研究應與量性研究並重；評量工具可由社區指標取代個人指標；而研究計畫的主導者則應由研究者轉移到社區居民。
  This article used community heart health projects as examples to review the trend and development of community-based intervention programs in the US and European countries. The author explored the reasons for why there was no significantly effective outcome in many of these large-scale programs, and discussed the study designs and health indictors of such programs. From both review and discussion, the author suggested future research strategies in community-based intervention studies. Since the 1970s, many American and European research institutes have supported large-scale community-based intervention programs aiming at preventing cardiovascular diseases. In many programs, the prevalence of risk factors and cardiovascular disease had been lowered in the intervened communities that were the subject of intervention. The controlled community, however, also showed the same secular changes over in the long-term research period. Statistically speaking, there were no significant differences between the experimental and control groups. The author reviewed some new research designs and new approaches in community-based intervention studies. As a conclusion, the author suggest that future community-based studies should consider environmental and policy changes as well as individual behavior changes; apply both qualitative and quantitative methods, replace individual-level indicators with community-level indicators, and shift the directorship of the program from investigators to community participants.
• 461 - 470
• 10.6288/TJPH2005-24-06-01

• Link 原著 Original Article
• 台灣北部國小四年級學童曾經發生自殺意念之相關因素研究Ever Having Suicide Ideation among the 4(superscript th) Graders in Northern Taiwan and Its Correlates
• 江宜珍、吳肖琪、李蘭
  Yi-Chen Chiang, Shiao-Chi Wu, Lee-Lan Yen
• 自殺意念 ； 兒童 ； 憂鬱 ； 社交孤寂 ； 城鄉差異
  suicide ideation ; children ; depression ; social loneliness ; urban and rural disparity
• 目標：本研究之目的在瞭解台灣北部國小四年級學童曾經發生自殺意念之比率，並進一步釐清其相關因素。方法：本研究利用「兒童與青少年行為之長期發展研究」（Child and Adolescent Behaviors in Long-Term Evolution，簡稱CABLE）2001年的資料進行次級資料分析。研究樣本取自台灣北部之台北市（代表都會地區）及新竹縣（代表鄉村地區）的18所國小四年級學童，共2,075人，並納入l,652位學童父親及l,841位學童母親的資料進行分析。結果：國小四年級學童「曾經發生自殺意念」之比率為19.77%，且台北市的比率(26.63%)為新竹縣(l2.18%)的2倍以上。在控制所有相關因素，並加入性別與其餘變項之交互作用，以邏輯斯逐步複迴歸分析後發現，曾有自殺意念者之特質為：居住於台北市、物質使用頻率較高、憂鬱程度較高、母親年齡較大、受父母懲罰程度較高、家庭支持程度較低之學童，以及社交孤寂感較高之女性學童。進一步將兩地區之資料分別分析，可發現具有明顯之城鄉差異。結論：本研究結果將可作為兒童自殺意念防治策略之參考，並據此提出下列建議：1．父母及老師應隨時關心有憂鬱傾向、社交孤寂感、物質使用行為、居住於城市地區之學童，是否有自殺意念之產生；2．父母應給予學童適當的支持，並對其採取合宜之懲罰方式；3．學校及家庭均應繼續加強學童之生命教育；4．學校於學童的健康檢查中，可考慮增設「心理健康篩檢」項目，以達早期發現之效；5．強化心理輔導與諮詢管道，以降低學童發生自殺的可能性。
  Objectives: The purposes of this study were to realize the rate of children in 4(superscript th) grade who had ever had suicide ideation and to investigate the correlates of this. Methods: Data were obtained from a longitudinal study, Child and Adolescent Behaviors in Long-term Evolution (CABLE), which was conducted in 2001. The sample involved 2,075 fourth graders, 1,652 fathers and 1,841 mothers in northern Taiwan. Results: It was found that the prevalence of ever having suicide ideation among children was 19.77%. The rate in Taipei City was more than twofold that of Hsin-Chu County (26.63% vs. 12.18%). Results of the stepwise logistic regression procedure showed that resident area, substance use, depression, social loneliness, mother's age, parental punishment and family support were the significant variables related to ever having suicide ideation include. It also showed that there is significant disparity between children living in urban and rural area. Conclusions: In order to prevent suicide ideation arising among children, parents and teachers should pay more attention to children's problem behaviors and emotion status. Children need greater family support and appropriate punishment. Those who have suicide ideation should be screened as early as possible. Life education and social skills are suggested in primary schools.
• 471 - 482
• 10.6288/TJPH2005-24-06-02

• Link 原著 Original Article
• 網際網路中瘦身網站之品質評估Quality Evaluation of weight-loss Information on the Internet
• 簡曉靜、吳振龍、陳育慧、馬（卄靄）萱、莊媖智、陳富莉、莊坤洋
  Hsiao-Ching Chien, Chen-Long Wu, Yu-Hui Chen, Sandra Ai-Hsuan Ma, Ying-Chih Chuang, Fu-Li Chen, Kun-Yang Chuang
• 網際網路 ； 資訊品質 ； 瘦身
  world wide web ; quality of information ; weight-loss
• 目標：本研究將以瘦身為主題，從訊息呈現的結構性、功能性與正確性等面向，評估瘦身網站的品質。方法：由兩位研究者利用雅虎奇摩及番薯藤兩個搜尋引擎，以「瘦身」、「減肥」為關鍵字進行搜尋，篩選出120個瘦身網站，並使用內容分析法，針對網站基本資料與特性、結構性品質、功能性品質與內容品質等面向，進行瘦身網站內容的譯碼工作。資料分析方面，利用皮爾森積差相關分析檢定雙變項間的相關性，以及利用ttest比較兩組間的差異性，並利用複迴歸分析網站內容品質的重要預測因子。結果：有80%以上的網站未說明作者、來源與時效，有提供電子信箱的網站佔72.5%，有線上提問或評論機制的比例則僅30.0%，有80%以上的網站內容沒有說明每日最低攝取熱量、運動強度、運動類型與熱量消耗，或減重目標等資訊。控制其他變項後，複迴歸分析結果指出，無商業行為、有提供作者資料的網站有比較好的內容品質，且皆達到統計上顯著相關。結論：大部分網站並未達到本研究所採用之結構性或功能性品質指標，且整體上內容品質不佳。有商業行為的網站，可能會為了推銷產品，因而迴避某些瘦身減重的資訊。民眾在檢視減重資訊時，可參考有與作者註記，當作一內容品質之指標。建議未來應定期進行橫斷式資料收集，以觀察網路上瘦身資訊的品質，且相關衛生單位應發展出健康減重的黃金標準，引導民眾以較有效率的方式獲得正確的資訊。
  Objectives: The purpose of this research is to assess the structural, functional, and content quality of weight-loss related websites. Methods: The 'Yahoo' and 'Yam' search engines were used to search for websites using ”weight-loss” and ”body sculpture” as keywords. A total of 120 websites were selected and their contents were analyzed. The basic characteristics and quality of the websites were coded according to predetermined criteria. Pearson correlation coefficient was calculated to test the association between two variables, and t test was used for group comparisons. Finally, regression was used to identify important predictors of quality. Results: More then 80% of the websites made no mention of authorship, sources, or publication date. However, 72.5% did provide the webmaster’s email address, and 30% contained a Q&A function. More than 80% of the websites did not provide information on the minimum daily calorific intake, exercise intensity and quantity, or the ideal goal of weight-loss. Regression showed that after controlling for other variables, websites not involved in commercial activity, or websites with authorship information tended to have better content quality. Conclusion: Overall, most websites did not meet the structural and functional quality criteria used in this study. Furthermore, the content of weight-loss information appeared to be poor. Websites involved in commercial activity may avoid providing certain weight-loss information in order to promote their products. When viewing weight-loss websites, authorship information can be used as a proxy for the quality of content. Periodic assessment of websites is essential in monitoring the quality of weight-loss information on the internet. Health agencies should develop a clear standard for healthy weight-loss, and to provide an effective channel for the general public to obtain the correct weight-loss information.
• 483 - 493
• 10.6288/TJPH2005-24-06-03

• Link 原著 Original Article
• 婦女健康指標之芻議Proposed Indicator of Women's Health
• 張玨、張菊惠、張嘉玲、許碧珊、張彥寧
  Chueh Chang, Chu-Hui Chang, Chia-Ling Chang, Bi-Shan Hsu, Yen-Ning Chang
• 指標 ； 婦女健康
  indicator ; women's health
• 目標：對於目前我國在發展婦女健康指標的架構，提出建議。方法：採用聯合國與世界衛生組織出版相關文獻，包括未開發與已開發地區如西太平洋地區及歐洲，並對照我國相關研究，彙整分析。結果：依據世界衛生組織2003年發表之婦女健康指標架構，以及收集之相關文獻，建議之婦女健康指標結構將健康分為三個層面：健康狀態指標、健康照護之外的重要健康決定因子，以及健康照護利用與品質，再以個人與社會國家層次來分列。結論：要發展具性別敏感的婦女健康指標，需要跳脫出傳統的醫療視野，並以本架構雛形住以實際既有大型資料庫進行性別分析，確實了解其資料的代表意涵。
  Objective: To propose a framework of indicators for women's health. Method: Archival analysis from data collected from UN & WHO, including developing and developed countries, in compared with women's health studies in Taiwan. Results: A framework has been proposed based on the definition of women's health from GWH, and all the archive collected, the perspectives from physical status, important health determinant other than health services and the quality of health care services. Conclusion: Further gender analysis should apply to those data bank from DOH and other national survey related to women' health.
• 494 - 503
• 10.6288/TJPH2005-24-06-04

• Link 原著 Original Article
• 南台灣的公共衛生問題：與北台灣的比較分析Public Health Problems in Southern Taiwan: Compared with Northern Taiwan
• 陳美霞
  Meei-Shia Chen
• 健康不平等 ； 南台灣 ； 疾病負擔 ； 南北差距 ； 公共衛生資源
  Health inequality ; southern Taiwan ; disease burden ; south-north disparity ; public health resources
• 目標：以南台灣為關注的焦點，本研究從社會、經濟、與人口，疾病負擔與平均餘命，及公衛資源等三個層面，與北台灣作比較，分析南台灣的公共衛生問題。方法：本研究資料來自行政院主計處、衛生署、內政部、以及環保署的各縣市有關上述三個層面的資料，再經計算得南北台灣的相關數據後做比較分析。南北台灣死亡率差距並以多餘死亡指數測量。結果：本研究發現南台灣的相對劣勢：南台灣人民的年收入比北台灣人民低，而且過去將近20年來不僅未曾改善，甚至南北差距加大；南台灣人民的教育程度較低，而過去將近20年來，南北的教育差距也未曾縮減；南台灣都市化程度較北台灣低，人口老化的速度過去二十年來比北台灣快。南台灣民眾十大死因的死亡率不但比北台灣高，而且這個差距在過去十多年來幾乎都是持續那麼大，甚至有些疾病的差距是越來越大。南台灣的民眾比北台灣平均約少活兩歲左右。在公共衛生資源方面，南台灣除了從事病後醫療的醫事人力及病床數資源與北台灣尚可比擬外，其他均比北台灣貧乏。結論：紓解南台灣如此不利的、長期持續落後北台灣的健康及公共衛生狀況最可能的出路是：公衛醫療專業與社區的結合。
  Objectives: This study analyzes southern Taiwan's public health problems by comparing them with northern Taiwan in three dimensions: socioeconomic status and population characteristics; disease burden and life expectancy; and public health resources. Method: The data are based on the county- and city-level statistics of the above three dimensions collected or compiled by Directorate General of Budget Accounting and Statistics of the Executive Yuan, Ministry of Internal Affairs, Department of Health, and Department of Environmental Protection. The relevant statistics for southern and northern Taiwan were than calculated and compared. For the comparison of mortality rates of the ten leading causes of death, the index of excess mortality was used to measure the gaps between southern and northern Taiwan. Result: The study found that southern Taiwan is much more disadvantaged than northern Taiwan: Its average annual income is much lower than that of northern Taiwan. Furthermore, in the past two decades, this disparity has increased. Southern Taiwan's average educational level is also lower than northern Taiwan's. This disparity has not decreased in the past two decades. Southern Taiwan is less urbanized and its population is aging much faster than northern Taiwan. The mortality rates of the ten leading causes of death are higher in southern Taiwan and the state of these inequalities has either persisted or worsened in the past one or two decades. The life expectancy of the population of southern Taiwan is about two years less than that of northern Taiwan. In terms of public health resources, other than the indicators of the numbers of medical providers and hospital beds, southern Taiwan is more disadvantaged than northern Taiwan. Conclusion: The best solution to southern Taiwan's persistently disadvantaged status is the integration and collaboration between the health and medical profession and the people in the communities in southern Taiwan.
• 504 - 518
• 10.6288/TJPH2005-24-06-05

• Link 原著 Original Article
• 預防保健的成本效益評估：以乳癌篩檢為例A cost-benefit Analysis of Preventive Care: The Case of Breast Cancer Screening
• 文羽苹、許玫玲
  Yu-Ping Wen, Mei-Ling Sheu
• 成本效益分析 ； 預防保健政策 ； 乳癌 ； 失能調整人年
  cost-benefit analysis ; prevention policy ; breast cancer ; DALY
• 目標：以乳房X光攝影為例，討論成本效益分析在全民健保預防保健政策評估的應用及限制。方法：採用衛生署癌症資料，藍忠孚與梁玲郁的「失能調整人年」DALY數據與健保支付標準，利用Maciosek等作者提出篩檢預期效益的計算方式，估計不同假設下乳房X光攝影篩檢乳癌的成本與效益。結果：成本效益分析顯示，二階段策略能降低篩檢成本，使篩檢符合成本效益的要求，高單價、低篩檢敏感度、偽陽性等因素可能使全面性乳房X光攝影乳癌篩檢有效益不敷成本之虞。結論：成本效益的分析可作為預防保健決策的一環，其重點在利用明確的方法與資訊，使各種意見可以得到充分討論。雖然在目前假設下全面篩檢不符成本效益，分析顯示，若能提高篩檢敏感度或降低篩檢單價，預防篩檢之預期效益將可以提高。我們建議健保相關政策亦可以利用成本效益分析，作為決策的重要工具。
  Objective: Use mammograms as an example to demonstrate the application and limitation of cost-benefit analysis on the preventive care policy of the National Health Insurance of Taiwan. Methods: Use the Cancer Report of the Department of Health (DOH), Disability-Adjusted Life Years (DALY) estimated by Lan and Liang, payment schedule of the Bureau of National Health Insurance (BNHI), and the methods of Maciosek et al. to estimate the benefits and costs of mammograms. Results: Cost-benefit analysis results suggest that a two-step screening strategy can effectively reduce costs and pass the cost-benefit test. High price, low sensitivity, and false positives tend to make it financially unworthy to indiscriminately screen for breast cancer in all women aged 50 to 69 by mammograms. Conclusions: Cost benefit analysis provides a framework for decision-making. Its strength lies in its systematic use of information, thus different opinions can be thoroughly discussed. While a full-scale mammogram does not currently pass the cost-benefit test, the analysis indicates that the expected benefits of screening can be increased through an increase in test sensitivity or a reduction in screening price. We recommend that policy-makers use cost-benefit analysis in the future to systematically examine the potential gains and losses of health care policies.
• 519 - 528
• 10.6288/TJPH2005-24-06-06

• Link 原著 Original Article
• CT及MRI醫療利用與影響費用因素Utilizations of CT and MRI and the Factors Associated with Expenditure
• 蔡文正、龔佩珍、楊志良、江怡如
  Wen-Chen Tsai, Pei-Tseng Kung, Chih-Liang Yaung, Yi-Ju Chiang
• 電腦斷層攝影掃描儀 ； 核磁共振掃描儀 ； 高科技醫療利用 ； 高科技儀器
  CT ; MRI ; High-tech Medical Utilization ; High-tech Equipment
• 目標：全民健保實施後，高科技醫療的使用成為醫療費用上升的主要因素之一。高科技貴重儀器中以電腦斷層攝影機(CT)及核磁共振掃描儀(MRI)之醫療費用最高，本研究探討電腦斷層攝影機(CT)及核磁共振掃描儀(MRI)醫療利用情形，分析影響其醫療費用之相關因素。方法，以台灣全民健保資料庫之全國申報資料，針對1998至2001年四年間CT及MRI利用情形，分析CT及MRI門診與住院醫療利用率及成長趨勢，並應用複迴歸分析找出影響CT及MRI醫療費用之相關因素。結果：2001年CT與MRI門診每千人利用率為1.38與0.45，住院每千人利用率為87.28與15.96。1998至2001年CT與MRI之門診年平均成長率為4.47%與18.54%，CT與MRI住院年平均成長率為-2.52%與4.90%。CT及MRI之門診利用率仍高成長，而住院利用率成長較趨緩。MRI於儀器較低密度區成長快速，CT成長則明顯較小。一週內CT及MRI在門診與住院多次利用率逐年顯著下降。在控制其他變項下，一地區的CT或MRI儀器人口比、醫院醫師人口比、女性人口比率對每人每年CT或MRI使用費用呈顯著正相關；但是一地區平均家戶所得對CT及MRI之利用費用為顯著負相關。幼兒人。比率及老年人口比率對CT或MRI之費用無顯著影響。結論：醫療供給面因素的增加，對CT及MRI之費用成長影響較大，而醫療需求面中之人口年齡結構的變化則較無影響。藉由審查管理制度的介入，對CT及MRI多次利用的監控有一定的成效。
  Objectives: Following the implementation of National Health Insurance, high-tech medical devices have become one of the main factors causing an increase in health care expenditure. Among the expensive medical devices, CT and MRI have the highest expenditure. This study investigates CT and MRI utilization and the factors that affect CT and MRI expenditure in Taiwan. Methods: This study used nationwide CT and MRI claim data for the years 1998 to 2001 from BNHI in Taiwan. We analyzed the trend of CT and MRI utilization at outpatient and inpatient services. Multiple regression analysis was the statistical method to determine the factors that influence the expenditure on CT and MRI. Results: In 2001 the rate of CT and MRI utilization for outpatients was 1.38 and 0.45 per 1000 patients, and the rate of inpatient use was 87.28 and 15.96 per 1000 patients. From 1998 to 2001, the annual growth rates in CT and MRI utilization for outpatients were 4.47% and 18.56%, whereas the annual growth rates for inpatients were -2.52% and 4.90% respectively. The rate of CT and MRI utilization for outpatients is still growing at an increasing rate while it become stable for inpatients. The multiple use of CT or MRI procedures in one week has significantly decreased. The CT or MRI-population ratio, hospital-based physician-population ratio, and female ratio have a significantly positive relationship with CT or MRI expenditure after controlling for other factors. Average family income significantly has a negative relationship with CT or MRI expenditure. However, the proportion of pediatric (?14 years) population and aged (?65 years) population didn't significantly influence CT or MRI expenditure after controlling for other factors. MRI and its utilization increase rapidly in areas with a low MRI-population ratio, whereas increases in CT units and utilizations have distinctly lower rates. Conclusion: Increases in supply-side health care resources have had more impact on the growth in CT and MRI expenditure than that of demand side. However, changes in the population's age structure will not significantly increase CT or MRI expenditures. The utilization review policy was an effective control on the multiple use of CT or MRI.
• 529 - 538
• 10.6288/TJPH2005-24-06-07

• Link 原著 Original Article
• 基層醫師對實施總額預算初期成效之評價－以健保中區分局轄區為例Evaluating the Preliminary Achievements of the Global Budgeting Payment System from the Perspective of Primary Care Physicians in Central Taiwan
• 葉德豐、楊銘欽、王俊文、張睿詒
  Te-Feng Yeh, Ming-Chin Yang, Jiunn-Wen Wang, Ray-E Chang
• 總額支付制度 ； 醫師團體 ； 基層醫師
  Global budgeting payment system ; physician organization ; primary care physician
• 目標：本研究的目的旨在探討基層醫師在總額支付制度實施後對總額委員會管理制度的評價，包括同儕制約、提升專業自主性、保障執業收入、審查制度合理化、提升醫療品質、提升醫病關係等。另徵詢基層醫師對於高額折付以及醫院、基層之門診總額是否合併之意見。方法：本研究採取自行設計之結構式問卷，以92年2月23日為基準日，採用分層系統抽樣的方式自中部四縣市與健保局特約之1715家西醫診所抽取200家為研究對象，回收有效問卷144份，回收率為72%。結果：基層醫師對提升專業自主性、同儕制約、審查合理性、保障執業收入等策略的同意度較高；對於有提升醫療品質與醫病關係等策略的同意度與不同意各半。只有約半數的醫師贊成實施高額折付，卻只有不到二成的醫師贊成基層與醫院門診總額合併。結論：從本研究的結果可以發現，醫師團體較傾向於採取保護團體成員收入與專業自主性的策略，對於提升品質的策略較無法顯現。本研究建議醫師團體應逐步利用累積的資訊建立更完善的品質提升措施，並在點值逐步下降的時候思考如何在保障會員權益與提升效率中求取平衡點，以追求永續發展。
  Objectives: The objectives of this study are to discuss the primary care physicians' evaluation of the impacts on physician organization following the implementation of the global budgeting system (including peer review, promoting professional autonomy, ensuring income, rationalizing the auditing system, improving quality of care, and improving the physician-patient relationship) and the agreement upon a discount for high-volume services and the budget combination between primary and hospital outpatient accounts. Methods: This study adopted the survey method of a self-designed structured questionnaire. It used the stratified systematic sampling method to select 200 western medicine clinics in central Taiwan from a total of 1715 clinics on February 23, 2003. Finally 144 valid responses were received with a response rate of 72%. Results: Results show that the agreement on the improvements in professional autonomy, peer pressure, rationality of utilization review, and secured income is relatively high. However, the agreement on the improving quality of care and improving the physician-patient relationship is relatively low. Half of the physicians agreed to adopt a discount for over-the-ceiling income physicians, but less than 20% of the physicians agreed with a lump sum budget combining the primary care and hospital outpatient sectors. Conclusions: This study found that physician organizations tend to adopt protective strategies rather than efficiency strategies for primary care global budgeting system. This study suggests that the physician organization should utilize accumulated information to build a more comprehensive quality improvement system, and try to reach a trade-off between ensuring member's interests and improving efficiency when reimbursement values progressively dropping.
• 539 - 547
• 10.6288/TJPH2005-24-06-08

• Link 實務 Public Health Practice
• 健保局DRGs對台灣病例變異解釋力之初探A Pilot Assessment of the Variation and Explanation of the BNHI-DRGs for Cases in Taiwan
• 陳琇玲、楊銘欽、薛亞聖、楊捷如
  Hsiu-Ling Chen, Ming-Chin Yang, Ya-Seng Hsueh, Chiech-Ju Yang
• DRGs ； 變異係數 ； 解釋能力 ； 健康保險
  DRGs ; coefficient of variation ; explanation ; health insurance
• 無
  Objectives: The purpose of this study is to determine the coefficient of variation (CV) and the explanation of the BNHI-DRGs in order to provide suggestions for Taiwan. Methods: The research data is derived from the 2001 National Health Insurance Research Database of the National Health Research Institutes. After blending two data files, combining the same patient data, and also dropping out primary care datasets, we used the BNHI-DRGs (version 1) for group cases. Then we analyzed the coefficient of variation (CV) and explanation (R^2) after deleting the outliers. Results: We determined the CV and R^2 of the charges and lengths of stay (LOS) for 495 DRGs and R^2 for each MDC. For both the charges and LOS, most CV values of the DRG are between 0.5 and 1.0. The overall charge explanation value is 0.39 and LOS explanation is 0.28. After excluding the case payment corresponding DRGs, the charge explanation is found to be 0.35 and LOS explanation 0.27, and there are significant negative correlations between CV and R^2 (p<0.01) with r=-0.5 for both the charge and LOS. Conclusions: (1) Whether or not the case payment corresponding DRGs are included, the BNHI-DRGs provides a better explanation for 2001 NHI inpatient charges than studies in other countries, indicating that it may be appropriate for DRGs to be put under a new payment system in Taiwan. (2) The DRGs amendment according to the CV of each DRG is a correct direction. However, referring to the explanation of individual DRGs is strongly suggested. (3) The BNHI should initially research DRGs with the explanation being near zero, medical partitioning, MDC4, MDC7, and MDC11. (4) The charge explanations for neonates (MDC15) in Taiwan are higher than the research results in other countries, but still less then the cases overall. When increasing neonatal DRGs, the BNHI should consider the possibilities of international comparisons occurring in the future. (5) The BNHI should set the criteria for identifying additional DRGs where a CC (complication and comorbidity) split appears most justified. Additional DRGs should not be split based solely on the presence or absence of a CC because hospitals may respond by changing coding practices to increase total payments, which would not represent a real increase in the severity of the overall mix of cases.
• 548 - 560
• 10.6288/TJPH2005-24-06-09