以全民健保1996-2001年承保抽樣歸人檔分析氣喘病人之醫療利用

Abstract

有鑑於氣喘盛行率日漸攀升，其所耗費之醫療資源亦相當可觀，故本研究利用國家衛生研究院所提供之全民健保承保抽樣歸人檔，期望能瞭解氣喘患者之醫療利用，以及可能影響其醫療利用之相關因素。因此針對氣喘患者進行兩部分之探討：一是以單次就醫為分析單位，探討氣喘患者之個人特質、季節、就醫場所等與醫療利用之關係；另一則是以一次療程為單位，探討氣喘患者之個人特質、季節等與其急性發作後三個月內醫療利用之關係。本研究之重要結果如下： 在單次就醫方面，性別對各項醫療費用皆無影響力，而年齡則以老年人跟小孩居多；而有重大傷病身份者，亦有較高之醫療費用，在醫院層級上，最常利用者為地區醫院，而在醫療費用上，以醫學中心最高；而就醫地點方面，以台北分局最多，東區分局最少。在季節方面，夏、冬兩季對費用之影響較大。門診部分之醫療費用平均為864.73元，診療及特殊材料費為102.02元，藥費為519.60元；住院部分之醫療費用平均為18,506.64元，不含病房費之醫療費用為12,977.15元，診療及特殊材料費為7,192.09元，藥費為3,843.49元；而在急診部分，平均醫療費用為1,499.59元，診療及特殊材料費為786.66元，藥費為326.13元。 在療程部分，年齡越大，醫療費用就越高；投保金額為24000-28800組，在總醫療費用、不含病房費之總醫療費用、總藥費、開藥天數及就醫次數上，相較於0-15840組都顯著較高，合併有心血管等其他併發症者，相較於有呼吸道併發症者有較高之總醫療費用；而無併發症者相較於有呼吸道併發症者，卻有較高之藥費。夏季較春季在總就醫次數上較多。一次療程之總醫療費用，平均需4,143.81元，扣除病房費平均需3,724.56元，藥費平均需1,226.84元，診療及特殊材料費平均1,641.24元，平均需就醫2.31次，開藥天數平均為14.58天，而平均住院天數為6.22日。 綜合本研究分析結果，在個人特質、季節、就醫場所特質等都有部分變項達統計顯著意義，可部分印證研究假說之推論。而根據研究之結果，建議衛生主管機關應多加重視孩童與老年人兩大族群，並宣導家庭醫師的重要性；亦可藉由分析氣喘患者之醫療利用情形，對氣喘醫療資源進行重新配置，如加強基層院所與民眾間的互動、對氣喘患者定期追蹤其健康情形、增設氣喘衛教師等，以提供氣喘患者更完善之醫療照護。 關鍵字：氣喘、醫療利用、全民健康保險、次級資料分析

As the prevalence rate of asthma increases, medical resource utilization also becoming huge. The objective of this study was to explore asthma patients’ health services utilization and the related factors that affects health services utilization. This study used Panel Claims Data of National Health Insurance Beneficiaries from 1996-2001. This study included two parts: one was based on single visit to verify the relationship among personal characteristics, season, and visiting place. Another was based on episodes that included all visit information in the three-months period after an acute attack. The results of this study are as follow: In terms of single visit, sex had no influences for health services utilization. Those who were the elderly, children or had major illness had higher medical expenses. District hospital had the most visit times, and Medical center had the highest medical expenses. In visit places, Taipei Branch had the most visit times and Eastern Branch had least visit times. In terms of season, summer and winter were related to expenses significantly. The average medical expenses per outpatient visit was NT$864.73, consultation and treatment and medical supply was NT$102.02, and average drug expenses was NT$519.60. In terms of expenses of hospitalization, the average medical expenses was NT$18,506.64, average medical expenses excluding ward fees was NT$12,977.15, consultation and treatment and medical supply was NT$7,192.09, average drug expenses was NT$3,843.49. In terms of expenses of emergency, the average medical expense was NT$1,499.59, consultation and treatment and medical supply was NT$786.66, and average drug expenses was NT$326.13. In terms of asthma episode, the older the age, the more the medical expenses. The enrollment payroll category at “24000-28000” had significantly higher amount of total medical expenses, total medical expenses excluding ward fees, total drug expenses, total days of prescription and total number of visits had higher expenses then the 0-15840 category. The asthma patients with cardiovascular or other complication also had higher total medical expenses then patients with respiratory complication. And the patients with no complication had higher drug expenses then those with respiratory complication. In terms of season, summer had more total number of visits then spring. The average medical expenses per asthma episode, average medical expenses excluding ward fees per episode, average drug expenses, and the total average consultation and treatment and medical supply were NT$4,143.81, NT$3,724.56, NT$1,226.84, and NT$1,641.24, respectively. The average visit was 2.31 times per episode, the average days of prescription were 14.58 days, and the average length of stay was 6.22 days. In conclusion, asthma patients’ health services utilization was significantly related to selected variables of the personal characteristics, season, and visiting places. According to the results of this study, this study suggest that public health organizations should pay more attention to children and the elderly, and promote the importance of primary clinics. Public health organizations also can re-allocate medical resources by analyzing health services utilization. For example, public health organizations can enhance the relationship between primary clinics and community, or to follow up patients’ health conditions regularly, or to add in asthma education qualified practitioner etc. to provide better medical care for the patients.

Key words: Asthma, Health service utilization, National Health Insurance, Secondary data analysis