臺灣健保自 1997 年大規模實施論病例計酬制度以來，各醫院開始採取成本管控措施， 如發展臨床路徑來降低醫療成本並維持醫療品質。本文採用回溯性及觀察性研究， 以接受甲狀腺切除術的患者資料為例，探討實施臨床路徑對醫療資源耗用的影響。我 們收集了 2001 至 2003 年某醫學中心 376 位接受甲狀腺切除術、論病例計酬的病患為 研究對象，比較臨床路徑實施前後，其醫療費用和住院天數的差異。實證結果顯示， 一般外科在實施臨床路徑後，平均住院天數及平均住院醫療費用均顯著下降（分別為 31.90% 及 14.98%）。此外，實施臨床路徑的一般外科之醫療資源耗用情形，也明顯 低於未實施該項目的耳鼻喉科。本研究證實，臨床路徑可有效降低醫療費用並提高患 者的醫療品質。未來可進一步研究實施臨床路徑的成本效益，以及其成本可能從住院 部轉移到門診部的潛在風險。

Taiwan’s National Health Insurance Administration (NHIA) began large-scale implementing the case payment method from 1997 with a view to reducing inpatient costs. Hospitals have adopted several management control systems such as Clinical Pathways (CPs) in response to the challenges of maintaining both fiscal soundness and the quality of medical care. The objective of this study is to assess the effects of CPs on the utilization of medical resources, particularly on the practice of thyroidectomy. We evaluate a total of 376 case payments for thyroidectomies operating in an academic medical center from 2001 to 2003 and compare differences between pre- and post-CPs implementation in terms of medical costs and Length of Stay (LOS). The empirical results show that after the implementation of the CPs, the reductions in LOS (31.90%) and in medical expenditure (14.98%) within the General Surgery (GS) department are statistically significant. In addition, the medical resource utilization in the GS division with CPs is significantly lower than that in the Ear, Nose, and Throat (ENT) division without implementing such a program. This study demonstrates that the CPs reduce hospital costs and improve the standard of medical care for patients. Further research is warranted to investigate the cost-effectiveness of CPs implementation and the potential risk of cost shifting from the inpatient to outpatient departments.

論病例計酬; 臨床路徑; 甲狀腺切除術; 住院天數; 醫療費用

case payment; Clinical Pathways (CPs); thyroidectomy; Length of Stay (LOS); medical expenses