楊銘欽臺灣大學:醫療機構管理研究所簡湘庭Chien, Hsiang-TingHsiang-TingChien2010-05-052018-06-292010-05-052018-06-292009U0001-0801200919082400http://ntur.lib.ntu.edu.tw//handle/246246/180792研究背景與目的：骨關節炎為一常見關節疾病，加上現時就醫模式多樣性，病人除西醫外還可選擇傳統中醫、中西醫併用等就醫模式，造成病人有複向醫療利用的現象。本研究主要目的在探討全民健康保險資料庫「骨關節炎病患」中醫、西醫及中西醫併用之醫療利用情形及其影響因素。究方法：研究資料乃利用2004-2005年全民健康保險資料之「門診處方及治療明細檔」之承保抽樣歸人檔第一組至第四組，擷取ICD-9-CM前三碼為715之病人為研究對象，將每筆人依首次就醫日往後追蹤一年，刪除大於一年資料，共3,841人，將其分為西醫、中醫、中西醫併用三組，分別為3,714人、67人、60人。以t檢定及變異數分析（Analysis of Variance, ANOVA）檢定資源耗用之差異，並採用逐步迴歸統計方法探討門診病人之中醫、西醫、中西醫併用治療之歸戶醫療資源利用情形與其影響因素。究結果：骨關節炎歸戶就醫部份，西醫門急診佔96.69%，中醫門診佔1.74%，中西醫併用佔約1.56%。病人特質方面，以女性居多，年齡為40-49歲、50-59歲、60-69歲最多；就醫時常見有合併或併發退化性脊椎炎及有關疾患者、合併軟組織之其他疾患、其他及未明示之背部疾患；西醫以就醫場所為私立、基層院所、台北分局居多；中醫歸戶就醫病人方面，權屬別以公立、基層院所、台北分局為主；中西醫併用歸戶就醫，以財團法人、基層院所、台北分局所轄範圍佔絕大多數。醫療利用方面，西醫歸人後門急診累計醫療費用平均值6,965.41點/人，累計就醫次數為6.33次/人，累計給藥日份平均80.55天/人。中醫歸人部份，累醫療費用平均值3,883.51點/人，累計就醫次數平均為4.93次/人，累計給藥日份平均為48.1天/人。中西醫併用歸人就醫記錄中，門急診累醫療費用平均8,132.72點/人，累計就醫次數平均為8.38次/人，累計給藥日份平均為95.13天/人。迴歸模式得知，骨關節炎病患就醫部份，西醫門急診累計醫療費用、累計給藥日份、累計就醫次數與性別、年齡、是否免部份負擔、合併症與併發症有顯著關係；中醫門診累計醫療費用、累計給藥日份與合併症與併發症有顯著關係，而累計給藥日份、累計就醫次數與健保分局別有顯著關係；中西醫併用門診累計醫療費用與性別、健保分局別有關，累計就醫次數及累計給藥日份與權屬別有顯著關係，病人採用西醫、中醫、中西醫併用之就醫模式與累計醫療費用、累計就醫次數有顯著關係。究結論：研究發現骨關節炎病患之性別、年齡、部份負擔、合併症/併發症及醫事機構權屬別、特約層級、健保分局別，皆會影響西醫、中醫、中西醫併用之醫療利用。Background and objectives: Osteoarthritis (OA) is the most common arthritis disease and there are various services nowadays. People can choose traditional Chinese medicine besides wstern medicine, which results in health services utilization of plural care phenomena. The purposes of this study were to explore health services utilization of western and traditional Chinese medicine by osteoarthritis patients under the National Health Insurance and its related factors. ethod: The source of the data came from claims data of the first to fourth sets of sampled registry of beneficiaries of National Health Insurance of 2004 and 2005. ICD-9-CM with initial three codes as 715 were selected from the panel database. Cases were traced for one year after the first visit in the claims file. A total of 3,841 patients were identified and divided into three groups, namely western medicine care group, Chinese medicine care group, and Chinese and western medicine care group. There were 3,714 patients in western medicine care group, 67 in Chinese medicine care group, and 60 in Chinese and western medicine care group. Data were analyzed by using student’s t test and Analysis of Variance (ANOVA). Stepwise regression analysis was used to explore health services utilization of western and traditional Chinese medicine and its related factors. esult: The proportion of patients using western medicine ambulatory care and emergency, Chinese medicine ambulatory care, Chinese and Western medicine ambulatory care and emergency were 96.69%, 1.74%, and 1.56%, respectively. In terms of patient characteristics, patients tended to be female, aged 40-49, 50-59 and 60-69 years old, with comobidity or complications of Spondylosis and allied disorders and Other disorders of soft tissues, other and unspecified disorders of back. For western medicine ambulatory care and emergency, the majority of patients received care from private hospitals, clinics, Taipei Branch. In accordance with Chinese medicine ambulatory care, people received care from public, clinics, Taipei Branch were in the majority. In personal visit of Chinese and Western medicine care, people received care from non-profit proprietary hospitals, clinics, Taipei Branch were in the majority. n terms of health services utilization patterns, the average accumulative medical expenses, accumulative days of prescription, accumulative number of visit for western medicine ambulatory care, were 6,965.41 points per person, 6.33 times, 80.55 days； for Chinese medicine ambulatory 3,883.51 points per person, 4.93 times, 48.1 days； and for Chinese and Western medicine ambulatory care 8,132.72 points per person, 8.38 times, 95.13 days. ultiple regression results indicate that osteoarthritis personal visit, ambulatory and emergency care accumulative expenses per patient visit for Western medicine, days of prescription, accumulative visit times were significantly related to gender, age, comobidities and complication, whether or not have to pay copayment. he accumulative expenses of Chinese medicine visits, days of prescription were significantly related to comobidities and complication, and days of prescription. Accumulative visit times were related to visiting place; ambulatory and emergency care. ccumulative expenses per patient visit for Chinese and Western medicine was significantly related to sex, visiting place. Accumulative visit times and days of prescription were significantly related to ownership of provider. Patients medical treatment models of Western medicine care, Chinese medicine care and Chinese/Western medicine care were significantly related to the accumulative medical expenses and accumulative visit times. onclusion:his study found that gender, age, copayment status, comobiditries/complication, ownership of provider, contracted category and visiting place of osteoarthritis patients were significantly related to the medical utilization of Western medicine care, Chinese medicine care and Chinese/Western medicine care.目錄試委員會審定書 I謝 II文摘要 IIIbstract V一章 緒論 1一節 研究背景 1二節 研究動機 3三節 研究目的 4二章 文獻探討 5一節 骨關節炎流行病學及定義 5二節 醫療服務利用模式 9三節 罹病成本 11四節 相關實證研究 13五節 綜合討論 17三章 研究材料與方法 21一節 研究架構 21二節 研究流程 22三節 研究假說 23四節 研究變項 24五節 研究材料 28六節 資料處理與統計分析 32四章 研究分析與結果 34一節 描述性統計分析 34二節 推論性統計分析 37五章 討論 95一節 重要研究結果之討論 95二節 研究限制 101六章 結論與建議 102一節 結論 102二節 建議 105考文獻 106文文獻 106文文獻 109目錄1-1 民國95年骨關節炎醫療費用(點數)統計-依年齡別分 21-2民國95年骨骼肌肉系統及結締組織之疾病門診醫療費用統計-按疾病別及院所分 22-1第一階段醫療服務利用行為模式（1960s） 103-1研究架構一 213-2研究架構二 213-3研究流程 224-1西醫、中醫、中西醫併用人數圓餅圖 524-2骨關節炎西醫門急診年齡分佈 924-3骨關節炎中醫門診年齡分佈 924-4骨關節炎中西醫門急診年齡分佈 92目錄2-1骨關節炎之醫療利用與罹病成本相關研究整理 183-1變項操作型定義 263-2資料處理過程 294-1骨關節炎西醫歸戶就醫之病人特質描述性統計，2004-2005 464-2骨關節炎西醫歸戶就醫之就醫場所特質描述性統計，2004-2005 474-3骨關節炎中醫歸戶就醫之病人特質描述性統計，2004-2005 484-4骨關節炎中醫歸戶就醫之就醫場所特質描述性統計，2004-2005 494-5骨關節炎中西醫併用歸戶就醫之病人特質描述性統計，2004-2005 504-6骨關節炎中西醫併用歸戶就醫之就醫場所特質描述性統計，2004-2005 514-7西醫、中醫、中西醫併用骨關節炎門急診歸戶就醫之醫療服務利用描述性統計，2004-2005 524-8骨關節炎西醫歸戶就醫之病人特質與西醫門急診累計醫療費用之檢定，2004-2005 534-9骨關節炎西醫歸戶就醫之就醫場所特質與西醫門急診累計醫療費用之檢定,2004-2005 544-10骨關節炎西醫歸戶就醫之病人特質與西醫門急診累計給藥日份之檢定，2004-2005 554-11骨關節炎西醫歸戶就醫之就醫場所特質與西醫門急診累計給藥日份之檢定，2004-2005 564-12骨關節炎西醫歸戶就醫之病人特質與西醫門急診累計就醫次數之檢定，2004-2005 574-13骨關節炎西醫歸戶就醫之就醫場所特質與西醫門急診累計就醫次數之檢定，2004-2005 584-14骨關節炎中醫歸戶就醫之病人特質與中醫門診累計醫療費用之檢定，2004-2005 594-15骨關節炎中醫歸戶就醫之就醫場所特質與中醫門診累計醫療費用之檢定，2004-2005 604-16骨關節炎中醫歸戶就醫之病人特質與中醫門診累計給藥日份之檢定，2004-2005 614-17骨關節炎中醫歸戶就醫之就醫場所特質與中醫門診累計給藥日份之檢定，2004-2005 624-18骨關節炎中醫歸戶就醫之病人特質與中醫門診累計就醫次數之檢定，2004-2005 634-19骨關節炎中醫歸戶就醫之就醫場所特質與中醫門診累計就醫次數之檢定，2004-2005 644-20骨關節炎中西醫歸戶就醫之病人特質與中西醫門診累計醫療費用之檢定，2004-2005 654-21骨關節炎中西醫歸戶就醫之就醫場所特質與中西醫門診累計醫療費用之檢定，2004-2005 664-22骨關節炎中西醫歸戶就醫之病人特質與中西醫門診累計給藥日份之檢定，2004-2005 674-23骨關節炎中西醫歸戶就醫之就醫場所特質與中西醫門診累計給藥日份之檢定，2004-2005 684-24骨關節炎中西醫歸戶就醫之病人特質與中西醫門診累計就醫次數之檢定，2004-2005 694-25骨關節炎中西醫歸戶就醫之就醫場所特質與中西醫門診累計就醫次數之檢定，2004-2005 704-26骨關節炎病人歸戶採行中醫、西醫、中西醫併用之不同就醫模式與門急診累計醫療費用之檢定結果，2004-2005 714-27骨關節炎病人歸戶採行中醫、西醫、中西醫併用之不同就醫模式與累計就醫次數之檢定，2004-2005 714-28骨關節炎病人歸戶採行中醫、西醫、中西醫併用之不同就醫模式與累計給藥日份之檢定，2004-2005 714-29骨關節炎門急診歸戶病人特質與就醫模式之檢定 724-30骨關節炎西醫門急診複迴歸虛擬變項設定表 754-31骨關節炎中醫門診複迴歸虛擬變項設定表 774-32骨關節炎中西醫併用門急診複迴歸虛擬變項設定表 784-33骨關節炎西醫、中醫、中西醫併用門急診複迴歸虛擬變項設定表 794-34病人特質、就醫場所特質與西醫門急診累計醫療費用對數值之逐步迴歸分析 814-35病人特質、就醫場所特質與西醫門急診累計就醫次數對數值之逐步迴歸分析 834-36病人特質、就醫場所特質與西醫門急診累計給藥日份對數值之逐步迴歸分析 844-37病人特質、就醫場所特質與中醫門診累計醫療費用對數值之逐步迴歸分析 854-38病人特質、就醫場所特質與中醫門診累計就醫次數對數值之逐步迴歸分析 854-39病人特質、就醫場所特質與中醫門診累計給藥日份對數值之逐步迴歸分析 864-40病人特質、就醫場所特質與中西醫門急診累計醫療費用對數值之逐步迴歸分析 864-41病人特質、就醫場所特質與中西醫門急診累計就醫次數對數值之逐步迴歸分析 874-42病人特質、就醫場所特質與中西醫門急診累計給藥日份對數值之逐步迴歸分析 874-43骨關節炎歸戶病人不同就醫模式與門急診累計醫療費用對數值之逐步迴歸分析 884-44骨關節炎歸戶病人不同就醫模式與門急診累計就醫次數對數值之逐步迴歸分析 904-45骨關節炎歸戶病人不同就醫模式與門急診累計給藥日份對數值之逐步迴歸分析 93application/pdf831276 bytesapplication/pdfen-US骨關節炎健康保險門診醫療利用醫療費用中醫、西醫、中西醫併用OsteoarthritisNational Health Insurancehealth services utilization ambulatory caremedical expensesChinese medicine, Western medicine, Chinese and Western medicinethesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/180792/1/ntu-98-R96843007-1.pdf