目的：本研究利用全民健保資料庫探討論病例計酬制的實施對於兒童(小於16 歲)扁桃腺切除手術在醫療品質及醫療資源使用上的影響。方法：研究對象為1998 年3 月至2000 年3 月間，因扁桃腺增生或慢性扁桃腺發炎而接受腭扁桃腺摘除手術之兒童，共491 例，研究探討「論量」(224 例) 及「論病例」計酬(267 例) 兩組在手術預後、醫療資源耗用、及醫療費用上的差異。結果：「論病例計酬組平均住院天數(3.6±1.8天) 明顯比「論量計酬組」(4.2±1.4 天) 少，而「論病例計酬組」除檢查費、手術費、麻醉費較多外，其餘各單項申報費用均較「論量計酬組」少，其中以病房費、藥事費減少最多(p < 0.05)，而且也未有將費用轉嫁至門診的情形發生。有關再手術、再入院、併發症、以及是否延長住院等醫療不良事件個案數在論病例計酬制度下並未明顯改變。結論：論病例計酬制實施後能減少住院天數但不影響醫療品質及醫療資源的利用，然而，支付制度改變對於手術預後的影響仍需持續性的監測以確保醫療品質。

Background and Purpose: In this study, we investigated the impacts of implementationof a case payment system on the quality and medical utilization of pediatric (under 16 years old)tonsillectomies by analyzing theNationalHealthcare Insurance Database (1998~2000).Methods:In total, 491 pediatric patients were identified with tonsil hypertrophy or chronic tonsillitis whounderwent a tonsillectomy during the period from March 1998 toMarch 2000. Surgical outcomes,utilization of medical resources, and healthcare expenses were compared between groups ofpatients who were operated on before (224 patients) and after (267 patients) implementation ofthe case payment system for tonsillectomies. Analyseswere conducted using t-test and Chi-squaretest. Results: The average length of stay was shortened by 0.6 days (p < 0.05). Except for the labtest, anesthesia, and operation fees,most of the other service item claims were remarkably reduced.The ward fee and medication fee were most significantly reduced (p < 0.05), but there was no clearevidence to show that providers shifted costs to outpatient services. The outcomes index, such asreadmission, reoperation, complications, and prolonged hospitalization were indistinguishablebetween the 2 groups (p > 0.05). Conclusion: The implementation of a case payment systemproved to be effective in enhancing the efficiency of the practice of pediatric tonsillectomy byreducing the length of stay. However, determining the impact of the case payment system onsurgical outcomes may require continuous monitoring to enhance healthcare quality.