高品質低成本是現代化醫療追求的目標，但目前文獻大多為醫療成本或醫療品質擇一研究。因此，本研究針對外科手術建立成本及品質之評估模式，除了計算需求成本外，並以問卷方式調查病人滿意度以衡量醫療品質，藉此尋求較低成本且較高醫療品質之治療方式。
腕隧道症是手部常見的疾病之一，通常以開放式或內視鏡減壓手術治療。本研究以腕隧道症減壓手術進行實證研究，藉由發展之評估模式比較兩種手術方式，探討哪一種手術方式可以得到較低成本及較高的病人滿意度。所得之結果可提供病人、醫界、健保局三者做參考以利選擇何種方式來治療腕隧道症會最有效益。
本研究以台南縣某區域醫院曾接受過腕隧道減壓手術的病人為研究對象，在2008年10月至2009年6月期間，總計回收162份問卷，其中採用開放式及內視鏡手術方式之病人分別為82位及80位。本研究採用SPSS 15.0進行Mann-Whitney U Test檢定兩種手術方法在不同期間是否在醫療成本及病人滿意度有顯著差異。結果顯示醫療成本方面，開放式手術方式於急性期、癒合期及康復期三個不同期間均顯著低於內視鏡手術方式 (p-value 三期均為 0.000)。在病人滿意度方面，開放式手術方式於康復期顯著優於內視鏡手術方式 (p-value 為0.041)。
綜合以上結果得知，以開放式進行腕隧道減壓手術可獲較低之醫療成本及較佳之病人滿意度，顯示開放式減壓手術可以符合多數腕隧道症病人之期待。本研究所發展結合醫療經濟成本分析及病人滿意度之評估模式，可在考量病人滿意度與成本間取得平衡點，進行手術是否適合之評估，亦可作為評估其他外科手術之參考。

Medical care has entered a new era of providing the highest service quality with the lowest cost. However, most of the recent studies are focusing on either about costing analysis or service quality of healthcare. It is necessary to consider a model combing costing methodology with patient satisfaction measurement in order to compare the performance of endoscopic decompressive surgery with open decompressive surgery for patients with carpal tunnel syndrome (CTS).
CTS is the most common entrapment neuropathy. Surgical release of the flexor retinaculum is indicated in order to decompress the carpal tunnel. A healthcare costing model and the patient evaluation measure (PEM) questionnaire, which were developed in the previous literature, is used to investigate CTS patients from October 2008 to June 2009. A total of 162 questionnaires (82 open and 80 endoscopic surgery) were collected by neurosurgeon and orthopedic surgeon in a regional hospital postoperatively. Treatment costs were estimated from the database in the case hospital. Based on the statistical analysis, it is found out that the endoscopic surgery is significantly more costly than open surgery during acute stage (p=0.000), healing stage (p=0.000) and recovery stage (p=0.000), where the former one also has significantly higher PEM Score, which means a lower level of patient satisfaction, with the later one surgery at the recovery stage (p=0.041).
This study concludes that combination costing with patient satisfaction measurement is feasible and important to be used to compare different treatments. Furthermore, open surgery is superior to endoscopic decompressive surgery considering the cost factor and patient satisfaction. Besides CTS surgery, it is also suggested that other kinds of surgery should also apply proposed approach to satisfy customers effectively.

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