本研究可分為兩大部分，第一部份針對試辦計畫所包含之新增肺結核患者與相關醫師進行醫療品質與滿意度相關問卷調查。以描述性統計描述加入試辦計畫與未加入試辦計畫，完治與未完治之樣本患者特性，以及其醫療支出、患者之整體滿意度、完成治療之時間、完治率之情形，並且以t-test、卡方檢定及變異數分析等統計方法進行檢定。利用複迴歸分析（multiple regression analysis）找出影響患者對於治療之滿意度之相關因素。此外，並利用羅吉斯迴歸分析（logistic regression analysis）探討影響肺結核患者是否完成肺結核疾病治療之相關因素，由於研究的時間限制，本研究對於是否完治以治療後九個月之狀態為依據。第二部份採用健保資料庫進行醫療費用，完治率和治療時間分析比較，針對論質計酬試辦區域-健保局中區分局所管轄之區域（包含臺中縣、臺中市、彰化縣市及南投縣），2001年11月開始至2002年12月為止，納入試辦肺結核論質計酬制度之所有收案對象、未加入試辦計畫肺結核患者，以及試辦計畫開始前一年（2001年）的新增肺結核患者，並且已完成治療者為對象。
In Taiwan, not only the tuberculosis is one of leading
causes of death recently, but also the annual number of
death of tuberculosis is the highest among all infectious
diseases. In order to increase cure rate of tuberculosis,
improve treatment quality, and give more health care responsibilities
to the health care providers, the Bureau of National Health
Insurance (BNHI), since November of 2001, has implemented
the “quality payment” demonstration programs which included
the treatments for tuberculosis, breast cancer, cervical
cancer, asthma, and diabetes. The BNHI hopes to furnish
the patients with comprehensive health care services that
emphasize health care outcomes and qualities.
The purpose of this study was to evaluate the tuberculosis demonstration programs of quality payment. This study evaluated the differences of the cure rates, the treatment times, and treatment expenditures for tuberculosis patients between the demonstration program and current fee-for-services payment programs. In addition, the factors, which influenced the successful treatment to tuberculosis, were analyzed. The satisfaction of medical services for tuberculosis patients was examined. Finally, the physicians’ attitudes and opinions to the demonstration program were surveyed.
This study consists of two parts. In the first part, the study used the structured questionnaire to interview tuberculosis patients, and we also used questionnaire to survey the relative physicians’ opinions for the demonstration program. The descriptive statistics were used to compare patients’ characteristics, treatment expenditure, satisfaction of medical services, treatment times, and cure rate between the demonstration programs and non-demonstration program. Multiple regression analysis was conducted to explore the relative factors that influenced the patients’ satisfaction with treatment process and outcomes, and logistic regression analysis was applied to examine the factors that significantly affected tuberculosis patients if they could be cured within 9-month treatment. In the second part, based on NHI medical claim data this study conducted statistical analyses for comparing the spending, cure rate, and treatment time for tuberculosis patients between demonstration program and non-demonstration program. The study period was from January 2001 to December 2002. The samples comprised all tuberculosis patients who were new cases and were cured in demonstration program or non-demonstration program in 2002, and those who were new tuberculosis patients and were also cured in 2001 before the implementation of demonstration program.
The results showed that tuberculosis patients in the demonstration program indeed had shorter treatment times. According to the consequences of analyzing NHI medical claim data, there was 83.81% cure rate in terms of 9-month treatment for those participating in the demonstration program, and 57.60% cure rate for non-participants. Furthermore, the medical-center hospitals had the lowest 9-month cure rate as compared to other-level health care organizations. The average treatment time for cured patients under the demonstration program was 224 days, which was shorter than that of non-participants. The patients, however, in the demonstration program felt less satisfaction with treatment services. The main problems for many tuberculosis patients were a long period of medication and the side effects of medicines. For physicians, most physicians believed the demonstration program is helpful to increase cure rate, but they showed less satisfaction with claim procedures, claim software systems, and payment structures. There were still 25.34% of surveyed physicians who didn’t understand the demonstration program.
According to results, we propose the following recommendations: for the Bureau of NHI: (1) entirely implement the quality payment program for tuberculosis treatment; (2) enhance the interpretation of the quality payment program to health care providers; (3) improve the NHI claim process and relative regulations according to the opinions of physicians; (4) avoid to simultaneously implement quality payments and fee-for-service payments for tuberculosis treatment; (5) have the same NHI co-payment for tuberculosis treatment at any health care organizations; (6) establish an integrated management system between BNHI and the Center for Disease Control for managing tuberculosis patients. For health care organizations: (1) build an appropriate NHI claim procedure for tuberculosis quality payment; (2) develop the standard clinical guidelines for tuberculosis treatment; (3) encourage physicians to place their tuberculosis patients to participate in the quality payment program. For the relative physicians: (1) enhance to follow up the patients’ treatment status and compliance behaviors; (2) promote the communication with patients to increase patients’ satisfaction and health care quality; (3) increase the patients’ compliance of medicine by intensifying patients’ psychology for tuberculosis treatment.
Keywords: Tuberculosis, Quality payment, Cure rate,
Defaulted rate, Satisfaction.