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研究生:蔡眀足
研究生(外文):Tsai Ming-Tsu
論文名稱:台灣地區糖尿病病患及其視網膜病變的醫療資源耗用台灣地區糖尿病病患及其視網膜病變的醫療資源耗用
論文名稱(外文):Utilization of Diabetes and Diabetic Retinopathy among National Health Insurance enrollees in Taiwan
指導教授:蔡維河蔡維河引用關係
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:醫護管理研究所
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:2006
畢業學年度:95
語文別:中文
論文頁數:86
中文關鍵詞:糖尿病視網膜病變醫療耗用
外文關鍵詞:DiabetesDiabetic RetinopathyHealth Expenditure
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背景:目前全球約有一億三千五百萬以上的糖尿病患人口,隨著社會經濟的繁榮及國民生活型態的改變,糖尿病患的數目在全世界各地均有上昇的趨勢。由於糖尿病容易引發多種的併發症,這些併發症不僅嚴重的影響到糖尿病患的生活品質,也增加許多醫療上的經濟負擔。過去,有關糖尿病的研究多屬於以醫院為基礎的研究,或是針對特定地區為主的區域型研究;而糖尿病視網膜病變之流行病學或相關資源耗用相關研究亦同,多是屬於區域性之個案研究,缺乏全面性之研究。
目的:本研究計畫利用全民健保資料庫,觀察與分析台灣地區糖尿病患者之疾病及醫療費用關係。
方法:本研究採取橫斷性的研究,分析2004年台灣地區糖尿病患者之醫療費用及其影響因素。從國家衛生研究院全民健康保險學術資料庫中的二十萬筆歸人檔資料進行分析;接著根據ICD-9-CM診斷碼及降血糖藥品碼精確篩選出糖尿病患者4,988人,視網膜病變患者1,216人,進一步將糖尿病患者之人口學特性、系統疾病特性、視網膜病變嚴重度、醫療費用耗用等變項進行統計分析,以探討各變項之關係。
結果:本研究發現,在糖尿病患者醫療耗用分析中,台灣地區2004年糖尿病患者之平均總醫療費用支出為77,443元;其中,男性高於女性,年齡越高者的醫療費用越高,系統疾病嚴重度越高者及視網膜病變嚴重度越高者,其總醫療費用也越高。從複迴歸分析結果發現,影響糖尿病患者醫療費用之因素為性別、年齡、視網膜病變之嚴重度、合併之系統疾病類別,均達到統計上顯著差異。進一步從糖尿病視網膜病變併發症的有無,來觀察糖尿病病患的醫療資源耗用情況,發現台灣地區2004年糖尿病視網膜病變病患平均總醫療費用為128,661元,明顯高於無視網膜病變之患者,為無合併視網膜病變患者的2.02倍;其中,門診次數每年平均36.9次,比沒有視網膜病變的患者高9.6次,住院天數平均6.9天也比無視網膜病變患者高2.3天。
結論:台灣地區糖尿病患的醫療資源耗用的增加,的確值得我們注意與研究,而有糖尿病視網膜病變併發症的糖尿病患,在總醫療費用、門診次數、住院天數均高於沒有視網膜病變的病患。因此,由本研究可得知及早預防視網膜病變的發生與治療視網膜病變的併發症,對台灣地區糖尿病患者醫療費用的減少與醫療品質的改善,有相當的助益與實證。
Background: Due to changing social economics and life styles, the number of diabetic patients has gradually increased all around the world. Accompanying with increasing prevalence and incidence, health expenditure related to diabetics has also risen much more with in the past decades. Multiple systemic complications are found with diabetes, and they would not only influence quality of life of patients but also result in much economic burden including notorious diabetic retinopathy. In the past decades, most researches about diabetic retinopathy were hospital-based or regional studies. There are few population-based and comprehensive studies.
Purpose: A cross-sectional study in Taiwan is conducted to investigate health expenditure and associated factors among adult diabetics in 2004, including diabetic retinopathy.
Methods: The current research is based on the National Health Insurance academic database in 2004 with random sampling of 200,000 people from 23,750,000 people. Out of which, 4,988 diabetic patients are then identified according to ICD-9-CM codes and drug codes.
Results: The average amount of total medical expenditure of diabetic patients in Taiwan is 77,443 NT dollars in 2004. The significant associated factors are male gender, the elderly, and the severity of comorbidity. The average amont of total medical expenditure of diabetic patients with diabetic retinopathy is 128,661 NT dollars in 2004, which is higher than that of diabetic patients without diabetic retinopathy (about 2.02-folds). The average amount of OPD visits of diabetic patients with diabetic retinopathy is 36.9 times, which is still higher than that of those without diabetic retinopathy. The average length of hospital stay is 6.9 days, higher than that of those without diabetic retinopathy.
Conclusions:
In our current study, adult diabetic NHI enrollees with diabetic retinopathy are consistently more expensive than those without diabetic retinopathy. Demographic factors (gender, age) and clinical factors (comorbidity and retinopathy) are able to predict somewhat a portion of medical expenditure in 2004. This nationwide, population-based study provides strong evidence that controlling severity and comorbidity of diabetes itself along with diabetic complications (such as diabetic retinopathy) is worthy in terms of medical expenditure, OPD visits and days of hospital stay.
目錄 頁次

中文摘要……………………………………………………………….4

英文摘要……………………………………………………………….6

壹、研究動機
一、糖尿病之盛行率及死亡率逐年攀升………..………………...8
二、醫療費用支出龐大且逐年增加……………………………...9
三、糖尿病視網膜膜病變之重要性……………………………...10
四、糖尿病及視網膜病變之研究多屬於區域性之調查
,缺乏全面性之結果………………………………………...12
五、台灣地區糖尿病視網膜病變之相關研究
鮮少探討醫療資源耗用……………………………………...13

貳、研究設計與資料分析
一、研究材料……………………………………………………15
二、研究方法……………………………………………………17
三、統計分析方法………………………………………………20

参、研究結果
ㄧ、 糖尿病患者之人口學特性及其醫療利用………………..21
二、 糖尿病視網膜病變患者醫療利用之相關分析…………..22
三、 糖尿病患者其門診及住院利用之複迴歸分析…………..25
四、 糖尿病患者其總醫療費用之複迴歸分析………………..28
五、 糖尿病患者其門住診處置費之複迴歸分析……………..29

肆、討論
一、資料正確性與個案疾病定義………………………………31
二、糖尿病個案與糖尿病視網膜病變…………………………32
三、糖尿病患者醫療費用………………………………………34
四、糖尿病患者視網膜病變與醫療費用………………………36

伍、研究限制與研究貢獻……………………………………………38

陸、文獻列表…………………………………………………………41

柒、附錄
表ㄧ、研究變項及操作型定義…………………………………51
表二、2004年糖尿病患基本資料及醫療費用描述…………...53
表三、2004年糖尿病視網膜病變有無之醫療利用比較……...54
表四、2004年糖尿病視網膜病變嚴重度之醫療利用比較…...54
表五、2004年糖尿病視網膜病變嚴重度
與其門診費用明細之關係……………………….………55
表六、2004年糖尿病視網膜病變嚴重度
與其住診費用明細之關係……………………….………55
表七、2004年糖尿病患者之門診及住院利用複迴歸分析…....56
表八、2004年糖尿病患者之總醫療費用複迴歸分析………....57
表九、2004年糖尿病患者門診及住院處置費之複迴歸分析....58
附件、降血糖藥物列表清單…………………………………….59
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