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研究生:梁煙純
研究生(外文):Yen-Chun Liang
論文名稱:我國多重慢性病患盛行率及醫療利用分析
論文名稱(外文):Prevalence, Utilization, and Expenditure of Multiple Chronic Conditions in Taiwan
指導教授:李丞華李丞華引用關係
指導教授(外文):Cheng-Hua Lee
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:2004
畢業學年度:92
語文別:中文
論文頁數:88
中文關鍵詞:多重慢性病患多重慢性狀態慢性病慢性狀態盛行率醫療利用
外文關鍵詞:Mutiple Chronic ConditionsChronic ConditionChronic DiseasePrevalenceUtilization
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目標:本研究之主要研究目的為:(1)定義慢性狀態及多重慢性狀態、(2)分析慢性狀態及多重慢性狀態之盛行率、(3)分析多重慢性狀態盛行率之影響因素、(4)分析多重慢性狀態之醫療利用率及醫療費用。
方法:本研究採用次級資料分析,主要利用2000年「全民健保學術研究資料庫」之20萬名樣本檔為觀察對象,並透過中央健康保險局的協助,進行門診費用明細檔、住院費用明細檔及戶籍資料檔等檔案之個人歸戶串聯,以2000年在保、設籍且非新生兒之本國國民,共計178,202人為本研究之研究樣本。並分為兩部份進行分析:(1)以描述性統計分別呈現人口特質變項及地理特質變項之多重慢性狀態盛行率,並以卡方檢定及簡單迴歸分析進行比較。再以多重對數迴歸分析控制相關變項後,進行多重慢性狀態盛行率之影響因子分析。(2)以描述性統計分別呈現有無多重慢性狀態者之醫療利用率及醫療費用,並計算其佔率,且進一步分析隨著慢性狀態個數的增加,醫療利用率及醫療費用的變化。最後,在控制相關變項後,分析慢性狀態個數對醫療利用率及醫療費用的影響。
結果:(1)我國2000年慢性狀態盛行率為28.12%,多重慢性狀態盛行率為17.75%,且平均每人患有0.62個慢性狀態;而65歲以上年齡層之慢性狀態盛行率為73.93%,且多重慢性狀態盛行率為62.63%。(2)年齡是影響多重慢性狀態盛行率的主要因素,且隨著年齡的增加,多重慢性狀態盛行率及平均每人慢性狀態個數皆隨之升高。(3)多重慢性狀態病患之每人每年平均西醫門診利用率是無多重慢性狀態者之2.93倍、每人每年平均住院利用率是無多重慢性狀態者之5.25倍。(4)多重慢性狀態病患之每人每年平均西醫門診費用是無多重慢性狀態者之6.34倍、每人每年平均住院費用是無多重慢性狀態者之7.84倍、每人每年平均總醫療費用是無多重慢性狀態者之5.64倍。(5)盛行率為17.75%之多重慢性狀態病患,其西醫門診利用率佔全體比率為38.70%、住院利用率佔全體比率為53.14%、西醫門診費用佔全體比率為57.76%、住院費用佔全體比率為62.86%且總醫療費用佔全體比率為54.89%。(6)隨著慢性狀態個數的增加,每人每年平均醫療利用率及平均醫療費用皆有明顯增加的趨勢。
結論:由研究結果可見,多重慢性狀態病患乃是我國醫療照護系統中最主要的資源使用者,且隨著我國人口結構的逐年老化,多重慢性狀態的盛行率將逐年升高,其醫療照護課題也將愈趨嚴重。就提高慢性醫療照護品質及控制醫療成本的觀點而言,改造現行醫療照護制度,使成為適合多重慢性狀態病患之整合性醫療照護模式乃是值得參考的政策方向。
附註:本論文之主要內容為第參章「分析我國多重慢性病患之盛行率及其影響因素」,及第肆章「分析我國多重慢性病患之醫療利用率及醫療費用」,此二章乃是根據本研究結果所撰寫之二篇獨立的文章,分別呈現本研究第一部份及第二部份之前言、材料方法、結果及討論。另外為配合本校醫務管理研究所之碩士論文格式規定,於是整合二篇文章之內容,呈現第壹章「緒論」、第貳章「文獻探討」及第伍章「討論」,並統一整理參考文獻於第陸章。
Abstract
Objectives: We aimed to analyze the prevalence, utilization and expenditure of multiple chronic conditions in Taiwan, and to study risk factors of multiple chronic conditions. Methods: This study adopted the National Health Insurance enrollment and claim data files provided by the National Health Research Institute in 2000. With the assistance of the Bureau of National Health Insurance, the researchers linked the enrollment files, the inpatient care claims data, and the household registry data. The study was conducted on a nationally representative sample of 178,202 beneficiaries who weren’t newborn and foreign in 2000. Multivariate logistic regression was used. Results: In 2000, (1) the prevalence of having any chronic conditions and multiple chronic conditions were 28.12% and 17.75% respectively, and the average number of chronic conditions per person was 0.62. The prevalence of the population aged 65 years and older of having any chronic conditions and multiple chronic conditions were 73.93% and 62.63% respectively. (2) Age was the major risk factor of having multiple chronic conditions. The probability of having multiple chronic conditions and the average number of chronic conditions increased with age. (3) The average utilizations per year of physician visits and hospitalizations of one person with multiple chronic conditions were 2.93 times and 5.25 times respectively more likely than people without any chronic conditions. (4) The average expenditures per year of physician visits and hospitalizations of one person with multiple chronic conditions were 6.34 times and 7.84 times respectively more likely than people without any chronic conditions. (5) In 2000, more than 50% of all NHI expenditures were related to the treatment of multiple chronic conditions. Conclusions: The prevalence of multiple chronic conditions was 17.75% in 2000, and the disproportionate medical expenditures associated with treating individuals with multiple chronic conditions. The prevalence is likely to increase by population ages. The trend was a very important reference in devising health related programs and policies.
Key words: multiple chronic conditions, chronic condition, chronic disease, prevalence, utilization
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