An Analysis of Primary Hepatocellular Carcinoma Patients’Repeated Medical Utilization for Confirmation and Related Factors
Date Issued
2009
Date
2009
Author(s)
Huang, Hsin-Hsun
Abstract
The purpose of the study was to understand hepatocellular carcinoma patients’ behavior of repeated medical utilization for disease confirmation and its related factors. Data were came from the longitudinal inpatient and outpatient claims of 100 million sampled registry from Taiwan National Health Insurance Research Database with patients suffering from hepatocellular carcinoma (ICD-9-CM 155, 155.0, 155.2) from 2005 to 2007. here were 1,282 new hepatocellular carcinoma patients in the data and 258 of them (20.12%) were classified as having repeated disease confirmation. Among those 258 patients, 114 patients (44.18%) switched from lower level hospital to higher ones to verify their diagnosis again. In terms of medical utilization, total repeated diagnosis fee and repeated examination fee (excluded the first time disease confirmation fee) were NT$1,272,765 and NT$3,783,983, respectively. The expenditures three months before and after hepatocellular carcinoma patients’ first time diagnosis, there was a 17.62% decrease of outpatient visits and 21.46% decrease of medical costs. actors associated with repeated disease confirmation were male, received therapy, and first time visit at unspecified department, private and regional hospital. Patients whose Charlson comorbidity index was zero or disease confirmation at lower level hospital had greater chance of seeking reconfirmation at higher level hospital. epatocellular carcinoma patients with duplicated medical expenditure tended to have multiple hospital visits, high level of enrollment payroll, did not have a major illness card, without hepatitis and cirrhosis, received embolization and surgical operation, and confirmation in lower level hospital, or hospitals lacated in Eastern Taiwan. Besides, the expenditure of examination in the first-repeated confirmation hospital was higher than that of first-diagnosis hospital (p<0.01), and highly related to having a Charlson comorbidity index greater than two, received chemotherapy, embolization, surgical operation and confirmation in medical center. Moreover, patients who skipped to higher level of hospitals for outpatient visit after confirmation was significantly related to high level of enrollment payroll, didn’t have hepatitis, and confirmation hospital located in eastern Taiwan.onclusions： Although 20.1% of hepatocellular carcinoma patients had repeated medical utilization to confirm their diagnosis within three months after first time diagnosis, but the percentage of outpatients skipped to higher level of hospitals declined.
Subjects
Hepatocellular carcinoma
Hospital-shopping
Repeated confirmation
Skipping grades of outpatient visit
Medical utilization
SDGs
Type
thesis
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