以全民健保1996-2001年承保抽樣歸人檔分析下背痛病人之醫療利用

Abstract

下背痛是常見且重要的臨床和國民健康問題，國內下背痛相關之醫療費用在健保支出佔了一定的比例，故本研究擬分析下背痛病人單次就醫和急性下背痛療程之醫療利用情形和影響因子。資料來源為全民健保資料庫承保抽樣歸人檔第一組和第二組1996-2001年資料，擷取ICD-9-CM前三碼為720、721、722、724，並扣除罹病部位明確為胸、頸部者為研究對象，計有下背痛門急診69,242人次，住院692人次，急性下背痛療程23,764個療程（下背痛發病後，治療期間在三個月之內者）。本研究之重要結論如下： 在1996-2001年下背痛單次就醫方面，西醫門急診佔85.0％，中醫門診佔14.1％，住院則有1.0％；病人特質上，以ICD-9-CM為724其他及未明示之背部疾患、女性、45-64歲，及私立醫院、基層院所、台北分局、內科系就醫者居多；醫療利用上，西醫門急診總費用平均為821.1元，中醫門診總費用平均為603.4元，住院總費用平均為37,380.5元。急性下背痛療程方面，以女性、16-44歲、投保類別為第一類固定雇主者、投保金額16,500-22,800元者居多；醫療利用上，每一療程就醫總次數平均為1.7次，各療程總費用平均為1,933.6元。 在下背痛單次就醫方面，西醫門急診各費用皆與下背痛ICD-9-CM、年齡、是否有重大傷病、就醫場所權屬別、特約層級、就醫地點、就醫科別有顯著關係；中醫門診各費用皆與年齡、就醫場所特約層級、就醫地點有顯著關係。住院各費用皆與下背痛ICD-9-CM、年齡、是否免部分負擔，和就醫場所特質之特約層級有顯著關係；急性下背痛療程方面，就醫總次數高低與年齡、投保類別、是否有慢性病有顯著關係；總費用（不含病房費）高低與年齡、投保類別、是否免部分負擔、是否有慢性病有顯著關係。 本研究發現下背痛ICD-9-CM、前傾因素之性別、年齡和投保類別、使能因素之投保金額、是否為低收入戶和是否免部分負擔、需要因素之是否有重大傷病和是否有慢性病、就醫場所特質之權屬別、特約層級、就醫地點和就醫科別，雖在細項費用上之顯著略有不同，但大致上皆為影響下背痛病人醫療利用之重要因素。

Low back pain is a common and important problem in terms of clinic and population health. Medical expenditures related to low back pain represent a certain proportion in the expenditures of National Health Insurance in Taiwan. The purposes of this research were to analyze health service utilization patterns and influential factors of single visit and acute low pack pain episodes for patients with low back pain. The source of the data came from claims data of the first and second set of sampled registry of beneficiaries of National Health Insurance from 1996 to 2001. ICD-9-CM with initial three codes as 720, 721, 722 or 724 were selected from the panel database. Cases with the illness located at cervix or thorax were excluded. A total of 69,242 person-times in ambulatory care and emergency, 692 person-times in hospitalization, and 23,764 episodes of acute low back pain (a treatment period that is equal or shorter than three months after an acute attack) were identified in the final analysis. The major results of this study were as follows: For low back pain single visit from 1996 to 2001, the number of services for western medicine ambulatory care and emergency, Chinese medicine ambulatory care and inpatient were 85.0%, 14.1% and 1.0%, respectively. In terms of patient characteristics, those had ICD-9-CM as 724 (other and unspecified disorders of back), being female, 45-64 years old, received care from private hospitals, clinics, Taipei Branch and internal medicine system were in the majority. In terms of health service utilization patterns, the average medical expenses for western medicine ambulatory care and emergency, Chinese medicine ambulatory care and inpatient were NT $821.1, NT $603.4 and NT $37,380.5, respectively. In terms of acute low back pain episodes, those who were female, being 16-44 years old, beneficiary category as categoryⅠ, had enrollment payroll category at NT $16,500-22,800 were in the majority. In terms of health service utilization patterns for acute episodes, the average number of visit was 1.7 times, and the average medical expense per episode was NT $1,933.6. In low back pain single visit, all kinds of ambulatory and emergency care expenses for western medicine were significantly related to the ICD-9-CM codes, age, whether or not having major illness, ownership of the provider, contracted category, visiting place and visiting department. All kinds of expenses for Chinese medicine ambulatory care were significantly related to age, contracted category and visiting place. All kinds of expenses of hospitalization were significantly related to ICD-9-CM codes, age, whether or not have to pay copayment and contracted category of the provider. In acute low back pain episodes, the number of visits per episode was significantly related to age, beneficiary category and whether or not having chronic diseases. The amount of medical expenses excluding ward fees was significantly related to age, beneficiary category, whether or not have to pay copayment and whether having chronic diseases. This study found ICD-9-CM codes related to low back pain, gender, age and beneficiary category of predisposing characteristics, the level of enrollment payroll, whether being low income family and whether paying copayment of enabling resources, whether having major illness and whether having chronic diseases of need, and ownership, contracted category, visiting place and visiting department of visiting place characteristics were important factors influenced low back pain patients’ health service utilization, although the significance on different fees were slightly different.