臺灣博碩士論文加值系統

本研究之目的首先在於了解高屏地區一年執行全人工髖關節置換術
(Total HipReplacement , THR) 之病例數與疾病分佈， 其次探討
高屏地區不同層級醫院及研究樣本執行 THR 之醫療費用與相關支出， 接
受全人工髖關節置換術病人之療效，並進一步以成本效果分析 (Cost-
Effectiveness Analysis, CEA) 探討全人工髖關節置換術之成本與效果
，期能提供保險政策、醫療服務之參考。研究樣本乃立意選取一家醫學中
心、準醫學中心、地區骨科專科醫院， 以 84 年 7 月至85 年 9 月間曾
在這些醫院執行過 THR 的病人為研究對象。 本研究以 Harris score 、
SF-36 、研究者自行設計之術後評估問卷三種工具進行療效評估，另有關
財務成本資料則來自健保局高屏分局之申報資料。研究結果發現三家樣本
醫院執行 THR 病人之疾病分佈以 AVN 佔 55.6% 最高，其次為 OA，佔
35.6% ；此分佈與高屏地區一年執行 THR 病人之疾病分佈 (AVN45.9% ,
OA41.4%)相似， 但與國外有較大差異。每件 THR 之醫療總費用平均約為
13 萬元，變異情形不大， 加上短期間之相關支出 ( 門診、醫療輔助器
材、看護費 ) 約有 14 萬元。 術後Harris score 總分之平均值達
89.1 分，符合文獻指標之優良效果。以 E/C ratio 評比THR 在不同年齡
層別、醫院別、疾病別間發現， 65 歲以下者之 E/C ratio 高於 65
或65 歲以上者， 地區骨科專科醫院高於其他兩家醫院， AVN 病人執行
THR 之成本效果比高於其他疾病， 亦即 65 歲以下者、地區醫院、及
AVN 病人與其比較組相較可以相同成本達到較好之療效。關鍵詞：全人工
髖關節置換術成本效果分析哈里斯量表(Harris score)經濟評估簡短
版-36

The purposes of this study are three-fold: 1) to understand the
incidence anddistribution of Total Hip Replacement (THR) cases
in Kaohsiung-Pingtung areas;2) to examine the medical care costs
associated with the operation of THR indifferent levels of
hospitals; and 3) to evaluate the effectiveness
andeconomic benefits of THR applying Cost-Effectiveness
Analysis (CEA). Theimplications of the results can be useful
references for reimbursement policyplanning and THR providers.
Three hospitals, 1 medical center, 1 quasi-medical center,
and 1 localorthopedic hospitals, were committed to this study.
The patients who receivedTHR between July 1995 and September
1996 were eligible sample for datacollection. Three
measurement instruments were used for assessing
theeffectiveness of THR operation which included Harris Score,
SF-36, and primaryself-developed questionnaire by the research
team. The cost information of THRpatients were extracted from
the Kaohsiung-Pingtung Branch of the Bureau ofNational Health
Insurance.The results indicated that the most frequently
reported disease was vascularnecrosis (AVN) (55.6% of the
sample); followed by primary osteoarthritis (OA)(35.6%). The
findings are very similar to the distributions of
thepost-one-year THR cases in Kaohsiung-Pingtung areas, but are
different fromthe statistics of other countries. The total
medical care costs of THR werearound NT$ 130,000 per case.
If the costs associated with OPD follows,crutches and
care-helper fees, the total costs of THR per case would be up
toNT$140, 000. In terms of Harris Score, the effectiveness of
THR were rated asexcellent (89.1) as stated by the related
literature. The Effectiveness Costratio of those age 65 was
higher than those age 65 and above; the localorthopedic
hospital had higher EC ratio than it counterparts; patients
withAVN diagnosis had higher EC ratio than other patient groups.
In other words,the younger group, the local hospital and
AVN group are more costeffectiveness in receiving THR.Key
words: Total Hip Replacement; Economic analysis, Cost-
effectiveness analysis, Harris Score, SF-36