跳到主要內容

臺灣博碩士論文加值系統

(44.211.31.134) 您好!臺灣時間:2024/07/24 18:44
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:鄭振廷
研究生(外文):Chun-Ting Cheng
論文名稱:末期腎臟疾病病患定期血液透析醫療費用分析研究
論文名稱(外文):Studies on End-Stage Renal Hemodialysis Patients Medical Expenditure Utilization
指導教授:錢慶文錢慶文引用關係
指導教授(外文):Ching-Wen Chien
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:85
中文關鍵詞:末期腎臟疾病血液透析醫療費用
外文關鍵詞:End-Stage Renal DiasesHemodialysisMedical Expenditure Utilization
相關次數:
  • 被引用被引用:26
  • 點閱點閱:927
  • 評分評分:
  • 下載下載:164
  • 收藏至我的研究室書目清單書目收藏:7
末期腎臟疾病病患醫療照護費用成長快速,在健保預算中平永續經營原則下,深入分析影響末期腎臟疾病病患醫療耗用頻率及費用之因素,並建構末期腎臟疾病病患風險模式。健保局透過合理支付制度規避醫療院所選擇性照護,確保末期腎臟疾病病患得到公平透析醫療照護。本研究樣本為北區健保局2000及2001年領有重大傷病卡,年齡18歲或以上定期血液透析病患3,202位,連結腎臟醫學會2000年透析調查資料。顯著影響末期腎臟疾病病患醫療耗用因素有人口因子中年齡及性別;疾病因子中糖尿病、鬱血性心臟衰竭及腦血管中風;透析治療困子血清白蛋白濃度、Kt/V、及胸部X-光心肺比率;與先前醫療利用因子中門急診及住院就醫次數及費用。相關分析中以先前醫療利用因子之門急診就醫次數之相關係數0.642為最高,及總醫療費用之0.413次之。
影響因素單迴歸分析中,以先前醫療利用因子之2000年對2001年門急診就醫次數之判斷係數0.412(即41.2%變異解釋能力)為最高,門急診醫療費用18.5%,及住院費用13.3%次之。其它因素對醫療耗用解釋力均不高;如人口因子與疾病因子均在1%至2%,透析治療因子之血清白蛋白解釋醫療費用耗用可達4%。於風險計價模式複迴歸分析,2001年門急診平均就醫次數27.9次,模式最大解釋變異量(Adjusted R2)為42.8%;門急診平均累計費用NT $613,365.6元,最大解釋變異量為12.4%;住院平均0.68次,最大解釋變異量為18.5%;住院平均累計費用43,901.4元,最大解釋變異量為11.4%;住院平均累計透析費用12,006.4元,最大解釋變異量為13.8%;及總醫療平均累計費用657,266.9元,最大解釋變異量為6.9%。健保局可以鼓勵影響因素改善,並透過合理支付制度避免選擇性照護,讓醫療院所對末期腎臟病患提供公平且符合經濟效益醫療照護。
Since the implement of National Health Program in 1995, End-Stage Renal Disease (ESRD) patients had achieved high quality of medical dialysis care, alleviating financial burdens, and good accessibility to health care. Health expenditure of the Bureau of National Health Insurance (BNHI) has increased rapidly, based on the principle of balanced budgets we have to analyze those factors affecting ESRD patients medical expenditures and try to formulate the risk adjustor models in order to optimize the result on cost and effect. The factors in present study are those demographic variables, comorbidities, dialysis outcomes, institute characters and prior medical utilizations in year 2000. Medical visits and expenditure claims in year 2001 are the dependent variables in the multiple regression analyses. The eligibility criteria of our study are ESRD patients receiving regular hemodialysis treatments at least for 3 months in the territory of Northern Branch of BNHI, with age greater than 18, in the year of 2000 and 2001. The beneficiaries are linked with the Society of Nephrology data for medical and dialysis records in year 2000.
There are 3,202 ESRD patients in our study; with mean age 57.4 years and 52.7% are female. Those factors significantly influenced medical expenditures are demographic factors of sex and age, comorbidity factors of diabetes mellitus, congestive heart failure and cerebrovascular accident, dialysis factors of serum albumin, dialysis adequacy Kt/V, and cardiac-thoracic ratio, and prior medical utilization factors of number of visits and expenditure claims. Institute characters and number of medical staffs have no significant effect on medical expenditures. Prior medical utilization factors had the highest correlation coefficients; with number of out-patient clinic (OPD) visits 0.642 and total expenditure claims 0.413. In univariate regression analyses, prior medical utilization factors had the highest coefficient of determination ( R2); with number of OPD visits 41.2% the highest, with OPD expenditure claims 18.5%, and with in-patient expenditure claims 13.3%. The ability of other factors to explain the variances of coming medical utilization, R2, are not high, demographic and comorbidity factors of 1% to 2%, and serum albumin around 4%. In multivariate regression models; all factors enter by forced has the highest adjusted R2 of 42.8% on number of OPD visits in 2001 with mean 27.9, adjusted R2 of 12.4% on accumulative OPD expenditure claims in 2001 with mean NT $613,365.6, adjusted R2 of 18.5% on average number of admissions in 2001 with mean 0.68, adjusted R2 of 12.4% on accumulative OPD expenditure claims in 2001 with mean NT $613,365.6, adjusted R2 of 11.4 % on accumulative in-patient expenditure claims in 2001 with mean NT $43,901.4, adjusted R2 of 13.8% on accumulative in-patient dialysis expenditure claims in 2001 with mean NT $12,006.4, and adjusted R2 of 6.9% on accumulative total expenditure claims in 2001 with mean NT $657,266.9. We believe that BNHI will have to implement quality improvements on above significant factors through reasonable payment systems and ESRD patients high quality care will be maintained.
中文摘要 ………………………………………………. i
英文摘要 ………………………………………………. iii
簡寫表 ………………………………………………. vi
圖表目錄 ……………………………………………… vii
誌 謝 ……………………………………………… ix
第一章 : 緒論 ………………………………………… 1
第一節: 研究起緣 …………………………… 1
第二節: 研究目的 …………………………… 6
第二章 : 文獻探討 ………………………………….. 7
第一節: 末期腎臟疾病及透析治療現況 …… 7
第二節: 腎臟病患階段性整体照護計劃 …… 12
第三節: 末期腎臟疾病透析治療費用耗用….. 15
第四節: 醫療經濟學對醫療費用利用因子分析..19
第五節: 醫療費用分析統計方式 …………… 24
第六節: 影響末期腎臟疾病定期血液透析費用
因子探討 ………………………….. 27
第三章 : 研究材料及設計 ………………………… 30
第一節: 研究架構 ………………………… 30
第二節: 研究假設 ……………………….. 31
第三節: 研究變項及操作型定義 ………… 32
第四節: 研究方法 ……………………….. 38
第五節: 研究限制 ……………………….. 39
第四章 : 研究結果 ……………………….. 40
第一節: 描述性統計分析 ……………….. 40
第二節: 相關性分析 ……………………… 49
第三節: 迴歸分析 ……………………… 52
第五章 : 討論及結論 ……………………………… 67
第一節: 研究討論 ……………………….. 67
第二節: 研究結論 ……………………….. 73
第三節: 研究建議 ……………………….. 76
參考文獻 ………………………………………….. 78
Alonzo L. Plough, Susanne R. Salem, Micahael Shwartz (1984). Case Mix in End-Stage Renal Disease, Differences between Patients in Hospital-Based and Free-Standing Treatment Facilities, New England Journal of Medicine, Vol. 310: pp.1432-1436.
Avi Dor, Philip J. Held, Mark V. Pauly (1992). The Medicare Cost of Renal Dialysis, Evidence From a Statistical Cost Function, Medical Care, Vol. 30: pp.879-891.
Bernard Charra, Edouard Calemard, Martial Ruffet (1992). Survival as an Index of Adequacy of Dialysis, Kidney International, Vol. 41: pp.1286-1291.
Chern JY, Rossiter LF, Wan TTH (2000). Examining the real Effect of Prior Utilization on Subsequent Utilization, Research in the Sociology of Health Care, Vol.17: pp.237-249.
David B. Evans, Ajay Tandom, Christopher J. L. Murray (2001). Comparative Efficiency of National Health Systems. Cross National Econometric Analysis, British Medical Journal, Vol. 323: pp.307-310.
David L. Kaserman (1992). Reimbursement Rates and Quality of Care in the Dialytic Industry: A Policy Discussion. Issues in Law & Medicine, Vol. 8: pp.81-102.
De Palma JR (1971). Adequate Hemodialysis Schedule, New England Journal of Medicine, Vol. 285: pp.353-354,
De Vecchi, M. Dratwa, M. E. Weidemann (1999). Healthcare Systems and End-Stage Renal Disease ( ESRD) Therapies- An International Review: Costs and Reimbursement/Funding of ESRD Therapies, Nephrology of Dialysis and Transplantation, Vol. 14, Suppl. 6: pp.31-41.
E.Andrew Balas, Lanis L. Hicks, John Van Stone (1995). Financial Effect of Clinical Decisions: Case Study of a Dialysis Center, Journal of Medical Systems, Vol. 19: pp. 465-474.
Edward Attrill, H Keith Johnson (2000). The Cost of Clinical Dialysis-A Historical Perspective, Seminars in Nephrology, Vol. 20: pp.523-525.
F. Tediosi, G. Bertolini, F. parazzini (2001). Cost Analysis of Dialysis Modalities in Italy, Health Services Management Research, Vol. 14: pp.9-17.
Gotch FA, Sargent JA (1985). A Mechanistic Analysis of The National Cooperative Dialysis Study (NCDS), Kidney International, Vol. 28: pp.526-534.
G. Ardine de Wit, Paul G. Ramsteijn, Frank Th de Charro (1998). Economic Evaluation of End Stage Renal Disease Treatment, Health Policy, Vol. 44: pp.215-232.
Giuseppe Cannella, Ernesto Paoletti, Robert Delfino (1993). Regression of Left Ventricular Hypertrophy in Hypertensive Dialyzed Uremic patients in long-term Antihypertensive Therapy, Kidney International, Vol. 44: pp.881-886.
Hideo Hidai (2000). Need for an Incentive-Based Reimbursement Policy toward Quality Care for Dialysis Patient Management, Kidney International, Vol. 58: pp.363-373.
Howland J, Stokes J, Crane SC (1987). Adjusting Capitation using Chronic Disease Risk Factors: A Preliminary Report, Health Care Financing Review, Vol. 9, No.2: pp.15-23.
Jinnet B. Fowles, Johnathan P. Weiner, David Knutson (1996). Taking Health Status into Account When Setting Capitation Rates, Journal of American Medical Assocaitaion, Vol. 276: pp.1316-1321.
Jin-Yuan Chern, Louis F. Rossiter, Thomas T. H. Wan (2000). Examining The Real Effect of Prior Utilization on Subsequent Utilization, Research in the Society of Health Care, Vol. 17: pp.237-249.
Jonathan Howland, Joseph Stokes, Stephen C. Crane (1987). Adjusting Capitation using Chronic Disease Risk Factors: A Preliminary Study, Health Care Financing Review, Vol.9: pp.15-23.
John C. Hornberger, Alan M. Garber, Michael E. Chernew (1993). Is High-Flux Dialysis Cost Effective ? International Journal of Technology Assessment in Health Care, Vol. 9: pp.85-96.
Juan M. Fernandez, Maria E. Carbonell, Nelson Mazzuchi (1992). Simultaneous Analysis of Morbidity and Mortality Factors in Chronic Hemodialysis Patients, Kidney International, Vol. 41: pp.1029-1034.
Michael V. Rocco, J. Michael Soucle, David M. Reboussin (1996). Risk Factors for Hospital Utilization in Chronic Dialysis Patients, Journal of American Society of Nephrology, Vol.7: pp.889-896.
N. Lameire, P. Joffe, M. Wiedemann (1999). Healthcare Systems-an International Review: An Overview, Nephrology of Dialysis and Transplantation, Vol. 14. Suppl. 6: pp.3-9.
Paul Kurtin, Allen R. Nissenson (1993). Variations in End-Stage Renal Disease Patient Outcomes: What We Know, What Should We Know, and How Do We Find It Out? Journal of American Society of Nephrol, Vol. 3: pp.1738-1747.
Philip J. Held, Jose R. Garcia, BS, Mark V. Pauly (1990). Price of Dialysis, Unit Staffing, and Length of Dialysis Treatments, Americans of Kidney Disease, Vol.15: pp.441-450.
Robert N. Foley, Patrick S. Parfrey, John D. Harnett (1996). Impact of Hypertension on Cardiomyopathy, Morbidity and Mortality in End-Stage Renal Disease, Kidney International, Vol. 49: pp.1379-138.
Sargent JA (1983). Control of Dailysis by a Single-Pool Urea Model, The National Cooperative Study, Kidney International, Vol. 23, Suppl. 13: pp.19-25.
Scribner BH, Baccay PH, Holar EM (1972). The Current Status on Middle Molecules. Workshop on Dialysis and Transplantation, American Society of Artificial Internal Organs, Vol. 1: pp.76-79.
Sheldon Greenfield, Lisa Sullivan, Rebecca A. Silliman (1994). Principles and Practice of Case Mix Adjustment, Applications to End-Stage Renal Disease, American Journal of Kidney Disease, Vol. 24: pp.298-307.
Steven Sheingold, David Churchill, Norman Muirhead (1992). The Impact of recombinant Human Erythropoietin in Medical Care Costs for Hemodialysis Patients in Canada, Society of Science Medicine, Vol. 34: pp.983-991.
Srinivasan Beddhu, Frank J. Bruns, Melissa Saul (2000). A Simple Comorbidity Scale Predicts Clinical Outcomes and Costs in Dialysis Patients, American Journal of Medicine, Vol.108: pp.609-613.
Thomas JW, Lichtenstein R (1986). Functional Health Measures for Adjusting Health Maintenance Organization Capitation Rates, Health Care Financing Review, Vol. 7, N0.3: pp.85-95.
USRDS (1992). Comorbid Conditions and Correlations With Mortality Risk among 3,399 Incident Hemodialysis Patients, American Journal of Kidney Disease, Vol. 20, Suppl. 2: pp.32-38.
Van Vliet, Van de Ven (1993). Capitation Payments Based on Prior Hospitalizations, Health Economics, Vol. 2: pp.177-188.
Willaim F. Keane, Allan J. Collins (1994). Influence of Co-morbidity on Mortality and Morbidity in Patients Treated With Hemodialysis, American Journal of Kidney Disease, Vol. 24: pp.1010-1018.
William F. Owen, Nancy L. Lew, Yan Liu (1993). The Urea Reduction Ratio and Serum Albumin Concentration as Predictors of Mortality in Patients undergoing Hemodialysis, New England Journal of Medicine, Vol.329: pp.1001-1006.
William M. McClellan, caril Anson, Kay Birkell (1991). Functional Status and Quality of Life: Predictors of Early Mortality among Patients Entering Treatment for End Stage Renal Disease, Journal of Clinical Epidemiology, Vol. 44: pp.83-89.
Wu-Chang Yang, Shang-Jyh Hwang, Shoou-Shan Chiang (2001). The Impact of Diabetes on Economic Costs in Dialysis Patients: Experiences in Taiwan, Diabetes Research and Clinical Practice, in press.
中央健保局(2001), 中華民國90年全民健保統計, 台北市: 中央健康
保險局。
林森永, 楊長興(2001), 保險給付介入對末期腎臟疾病患者之影響評估, 碩士論文, 台北: 國立台北護理學院醫護管理研究所。
楊全斌(1997), 醫療費用的抑制與總額預算制, 牙醫界, 第16卷: 頁67-73。
李玉春(1995), 應用成本分析於全民健保醫療費用支付標準之探討, 會計研究月刊, 第118卷: 頁107-113。
藍忠孚, 洪錦墩(2000), 醫療費用總額支付制變之探討, 全民健康保險, 第 27卷: 頁9-13。
朱益宏, 錢慶文(2000), 全民健保長期洗腎病人論人計酬可行性之初探, 碩士論文, 台北: 國立陽明大學醫務管理研究所。
張碧玉, 毛荊雯(2001), 影響末期腎臟疾病患者血液透析醫療費用之風險因子探討, 碩士論文, 高雄: 高雄醫學大學健康科學院公共衛生學研究所。
盧瑞芬, 謝啟瑞(2000), 醫療經濟學, 台北市: 學富文化。
紀駿輝, 郎慧珠,李卓倫(2000), 全民健保醫療費用成長趨勢及其影響因素之分析, 行政院衛生署研究計劃DOH89-CA-1001。
賴永勳, 黃尚志,楊五常(1997), 台灣地區86年度透析評估工作報告, 中華民國腎臟醫學會雜誌, 第11卷: 頁177-212。
賴永勳, 黃尚志, 楊五常(1998), 台灣地區87年度透析評估工作報告, 中華民國腎臟醫學會雜誌, 第12卷: 頁157-195。
王偉華, 陳貽善, 莊懷德(2001), 醫療費用管理與新一代資訊系統架構, 經社法制論叢, 第27卷: 頁291-319。
阮子凌, 藍忠孚(1999), 診斷關聯群在我國之引進與發展, 全民健康保險, 笫19卷: 頁10-13。
楊五常, 黃尚志, 陳進陽(2000), 88台灣地區透析醫療品質指標建立計劃第一階段-工具建立, 行政院衛生署DOH89-NH-003。
顧進裕, 許國泰, 連榮達(1993), 台灣透析治療之現況 (上), 台灣醫界, 第37卷: 頁873-879。
謝其政, 張睿詒(1998), 利用全民健保資料建立風險計價模式之初探, 碩士論文, 台北: 國立台灣大學公共衛生學院醫療机構管理研究所。
譚柱光, 黃東波(1997), 人工腎臟, 台北市: 力大圖書。
張睿詒, 江東亮, 楊志良(1999), 以風險校正模型探討控制全民健康保險醫療費用之研究, 台北: 國立臺灣大學醫療机構管理研究所(行政院衛生署DOH87-NH-010)。
李奕慧, 葉金川(2000), 部份論人計酬制道可行性分析及模擬研究, 花蓮: 慈濟醫學暨人文社會學院公衛系(行政院衛生署DOH88-NH-019) 。
黃尚志,楊五常,陳秀熙(2000), 全民健保透析品質指標建立計劃:第二階段-監測及評估, 台灣腎臟醫學會(行政院衛生署DOH89-NH-028)。
列嘉祺, 鄭文輝(1999), 健保多元体制下風險調整機制之探計-台灣全民健保資料的實證分析, 碩士論文, 國立中正大學社會福利研究所。
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
1. 王柏山,2001。「台灣商業性養殖業之崛起與衰落─養鰻業與養蝦業之變遷與調適」,社會科教育研究。第6期,頁79-106。
2. 李佩郁、李朝賢,1996。「台灣菊花生產技術效率之分析」,農業金融論叢。第36期,頁93-123。
3. 李宗儒,2000。「以資料包絡法衡量台灣地區魚市場經營之相對效率」,農林學報。第49卷第3期,頁53-63。
4. 李武忠,1991。「台灣養蝦事業面臨之衝擊及因應對策(下)」,現代漁業。第44期,頁27-32。
5. 李武忠,1991。「台灣養蝦事業面臨之衝擊及因應對策(上)」,現代漁業。第42期,頁53-58。
6. 李武忠,1991。「台灣養蝦事業面臨之衝擊及因應對策(中)」,現代漁業。第43期,頁43-48。
7. 李武忠,1992。「養蝦事業海外投資的可行性研究」,中國水產。第480期,頁20-50。
8. 徐基新,1997。「養蝦循環水系統」,漁業推廣工作專刊。第14期,頁21-24。
9. 張靜貞、賴怡君,1999。「農會信用部的效率評估與風險管制」,農業金融論叢。第42期,頁33-58。
10. 陳秀男,1990。「從技術上探討台灣草蝦養殖產業之重建(下)」,漁友。第13卷,第6期,頁29-32。
11. 陳秀男,1990。「從技術上探討台灣草蝦養殖產業之重建(上)」,漁友。第13卷,第5期,頁21-24。
12. 陳秀男、張朴性、郭光雄,1995。「台灣地區養殖草蝦之疾病問題與對策」,中國水產。第514期,頁3-16。
13. 陳清春,1980。「台灣草蝦養殖經濟條件之探討」,農業金融論叢。第16卷,頁199-213。
14. 陳嘉鐘,1988。「台灣養殖蝦發展概況與外銷展望」,食品工業。第20卷,第7期,頁45-49。
15. 陳榮方,1998。「以資料包絡法評量我國大學校院之教育品質」,高雄科學技術學院學報。第28期,頁227-238。