A Study of Patient Controlled Analgesia and Strategy for the Medical Administration
Date Issued
2011
Date
2011
Author(s)
Wang, Mao-Hsien
Abstract
Background: The national health insurance is a blessing for the people of Taiwan! However, it challenges the management of the medical administration. The national health insurance is based on the structure of the foregoing labor insurance system which is a history now. Under the previous system, the bureau began to manage the total budget of national health insurance with discount of the point value and decreasing the discrepancy of the drug’s price. The running of a regional hospital becomes much more difficult! In our opinion, searching for the medical market of self-expense is important for the lasting of national health insurance system and the quality of medical institution.
Purpose: Patient controlled analgesia (PCA) is a self-expense medical service in Taiwan. PCA should utilize a specific machine and intravenous set bundled with. New machine of PCA increases the cost of the PCA system. By working on this issue, we have marked up the price of PCA service to maintain to profit. In this study, we would like to investigate the market share and probe into the behavior of the patient for the PCA system. By providing better medical service, we hope that we can have some discovery in this study.
Methods: We have sampled 66 patients from a regional teaching hospital in northern Taiwan. The method of PCA is by intravenous route. All the patients are ASA class I or class II. The items of census include gender, insurance, residency, income, body weight, body height, surgery and functionary. The census is completed at pre-anesthetic consultation except visual analogue score (VAS). The VAS is evaluated at day 0 and day 1 after the surgical operation.
Results: According to the results of the linear regression, PCA has strong relations with the decreasing VAS. It interprets that PCA is effective on postoperative pain control. The operations of joint replacement and thoracotomy have higher ratio of applying PCA than others. We conclude that patients received these operations should have a PCA service. Chi-Square shows no significance about gender, functionary, age, insurance, incomes and residency.
Strategy: After mark-up of PCA service, we find that the number of service keeps the pace as usual. A strategy for the medical administration might be the following: Ongoing the current pricing strategy is possible. Statistically, thoracotomy is highly related with PCA. Enforce the PCA service for the patient receiving major operation should have the positive meaning for developing the intensive medicine. Strategically, the developing of intensive medicine should be encouraged by the promotion of PCA service. By promotion of PCA, we encourage the surgery of joint replacement. The patient will not be afraid of post-operative pain to reject the operation. It will be a win-win situation. We should discuss the cost of PCA to adjust the pricing respectively and hope to provide better medical service. After all, the best control of cost is higher quality of medical service.
Subjects
Patient controlled analgesia
Postoperative pain
Medical administration
Type
thesis
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