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研究生:李文光
研究生(外文):Wen-Guang Lee
論文名稱:台灣失智症醫療利用及費用分析
論文名稱(外文):Health Care Utilization and Expenditure of Dementia in Taiwan
指導教授:譚秀芬譚秀芬引用關係
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫務管理學研究所
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:2008
畢業學年度:96
語文別:中文
論文頁數:78
中文關鍵詞:盛行率醫療利用醫療費用全民健保失智症
外文關鍵詞:prevalenceutilizationexpenditurenational health insurancedementia
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目的:失智症為慢性及進行性的疾病,會隨人口逐漸老化而益趨增多,探討其盛行率、醫療利用及費用在衛生資源配置及決策上非常重要,然國內全國性的失智症醫療利用相關研究甚為少見。因此本研究利用健保資料庫估計失智症之盛行率,探討失智症病患之醫療利用率及醫療費用之情形。
方法:本研究採次級資料分析,以2004年「全民健康保險研究資料庫」之20萬名抽樣檔為觀察對象,排除當年未納保及65歲以下者,共納入17,032人為研究樣本。研究樣本在2004年門診及住院檔中有1筆(含)以上主診斷或次診斷符合失智症定義(ICD-9-CM包括290、294.1x和331.0)即判定失智症,計算65歲以上老人失智症之盛行率,並探討影響失智症盛行率之因素。在失智症醫療利用及醫療費用的分析,則扣除2004年整年未持續納保者,共納入15,232人為樣本,使用Charlson comorbidity index的診斷分類作為評估共病之依據,並分析失智症對醫療利用及醫療費用的影響。
結果:(1)我國2004年65歲以上老人之失智症盛行率為4.07%。(2)年齡是影響失智症盛行率的主要因素,且盛行率隨著年齡的增加而升高,約每5歲即增加1倍,從65-69歲的1.43%大幅上升至85歲以上的12.51%。(3)失智症病患之每人每年平均門診利用率是無失智症者之1.2倍(34.7次 vs. 29.1次);每人每年平均住院利用率是無失智症者之3.0倍(0.9次 vs. 0.3次);每人每年平均住院天數是無失智症者之3.7倍(12.3天 vs. 3.3天)。(4)失智症病患之每人每年平均門診醫療費用是無失智症者之1.5倍(52,320元 vs. 35,683元);每人每年平均住院醫療費用是無失智症者之2.7倍(51,672元 vs. 18,925元);每人每年平均總醫療費用是無失智症者之1.9倍(103,992元 vs. 54,608元)。(5)失智症病患佔我國65歲以上人口之3.77%,但其門診利用率佔全體之比率為5.2%、住院利用率佔全體之比率為15.7%、門診醫療費用佔全體之比率為6.8%、住院醫療費用佔全體之比率為12.7%,且總醫療費用佔全體之比率達8.9%。
結論:在全國代表性樣本中,失智症和較高的醫療利用及費用有關,主要是因住院費用增加所致,未來的研究需要探討失智症病患高住院率的因素。衛生主管機關宜儘早規劃我國老人醫療照護體系,以減少失智症對我國醫療照護體系的衝擊。
Objectives: Dementia is a chronic and progressive disease and it is expected to increase as the general population ages. It is important to study prevalence, health care utilization and costs of dementia in order to allocate health resource and make strategic decisions. However, to date, less national wide study available on this issue in Taiwan. Therefore, this study used the health insurance database to analyse prevalence, health care utilization and cost of dementia.Furthermore, we explored the effect of comorbidity on health care utilizations and costs.
Methods: This study adopted the National Health Insurance enrollment and claim data files provided by the National Health Research Institute in 2004. Beneficiaries who under the age of 65 years and were not eligible for NHI in 2004 were exclude, leaving 17,032 beneficiaries available for this study. Those beneficiaries who had at least one service claim in the year 2004 for either ambulatory or inpatient care, with diagnosis of dementia (ICD-9-CM 290, 294.1X and 331.0) were selected to estimate prevalence of dementia in elderly. Besides, considering the utilization and cost, the beneficiaries who under the age of 65 years and had not been continuously eligible for all of the year 2004 were exclude, leaving 15,232 beneficiaries available for this study. Comorbid conditions were based on the diagnostic classifications from the Charlson comorbidity index. We examine whether people diagnosed with dementia in the NHI have higher health care utilization and cost compared with a relevant comparison group.
Results: (1) In 2004, prevalence of dementia was 4.07%. (2) Age was the major risk factor of dementia and dementia prevalence increased with age. Prevalence doubles approximately, for every 5-year interval, from 1.43% among people 65-69 years of age to about 12.51% among those aged 85 and over. (3) Mean annual utilization of physician visits, hospital admissions and length of stay were 1.2 times (34.7 vs. 29.1), 3.0 times (0.9 vs. 0.3) and 3.7 times (12.3 days vs. 3.3 days) higher for patients with dementia relative to nondementia patients, relatively. (4) Mean annual costs of outpatient costs, inpatient costs and total costs were 1.5 times ($52,320 vs. $35,683), 2.7 times ($51,672 vs. $18,925) and 1.9 times ($103,992 vs. $54,608) higher for patients with dementia relative to nondementia patients, relatively. (5) While dementia patients accounted for 3.77% of the elderly, they accounted for 5.2%, 15.7%, 6.8%, 12.7% and 8.9% of physician visits, hospital days, outpatient costs, inpatient costs and total medical costs to the NHI, respectively.
Conclusions: In a nationally representative sample, higher medical expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients. The public should be educated the symptoms of early stage dementia in order to early diagnosis and medical treatment and decelerate deterioration of the health functions.
目錄
誌謝 I
中文摘要 II
ABSTRACT IV
目錄 VI
圖表目錄 VIII
第一章 前言 1
第一節 研究背景及重要性 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 失智症介紹、流行病學和治療方式 4
第二節 共病的評估 12
第三節 失智症醫療利用及費用之實證研究 16
第四節 綜合討論 22
第三章 研究設計與方法 24
第一節 研究架構 24
第二節 研究假說 25
第三節 研究資料來源與樣本 26
第四節 研究變項及定義 32
第五節 資料分析方法 35
第四章 研究結果 36
第一節 失智症盛行率 36
第二節 失智症的醫療利用及費用 45
第五章 討論 63
第一節 失智症盛行率 63
第二節 失智症的醫療利用及費用 66
第三節 研究限制 68
第六章 結論與建議 69
第一節 結論 69
第二節 建議 71
參考文獻 72

圖表目錄
表 二 1 Charlson comorbidity index診斷分類、權重與ICD-9-CM codes對照表 14
表 二 2 失智症醫療利用及費用之實證研究 20
表 三 1 本研究資料來源和使用之欄位 27
表 三 2 本研究所定義之失智症診斷碼 29
表 三 3 變項名稱及定義 33
表 四 1 失智症盛行率研究樣本的自變項特性描述 38
表 四 2 各年齡層之失智症盛行率 39
表 四 3 人口特質變項及地理特質變項與失智症盛行率之關係 42
表 四 4 影響失智症因子之多重Logistic迴歸分析 44
表 四 5 失智症醫療利用及費用研究樣本的自變項特性描述 46
表 四 6 有無失智症者之共病盛行率 48
表 四 7 有無失智症者之每人平均共病個數及共病指數 49
表 四 8 有無失智症者之每人每年平均醫療利用率及醫療費用 54
表 四 9 有無失智症者之校正後每人每年平均醫療利用率及醫療費用 60
表 四 10 有無失智症者之醫療利用率及醫療費用佔全體之比率 61
表 四 11不同共病對有無失智症者之每人每年平均醫療費用影響 62
表 五 1 不同失智症定義對於盛行率的影響 65

圖 三 1 研究架構 24
圖 三 2 失智症盛行率研究流程圖 30
圖 三 3 失智症醫療利用及費用研究流程圖 31
圖 四 1 兩性各年齡層之失智症盛行率 40
圖 四 2 共病個數對每人每年平均門診次數的影響 55
圖 四 3 共病個數對每人每年平均住院次數的影響 56
圖 四 4 共病個數對每人每年平均住院天數的影響 57
圖 四 5 有無失智症者之每人每年平均醫療費用分佈 58
圖 四 6 共病個數對每人每年平均醫療費用的影響 59
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