臺灣博碩士論文加值系統

目的
本研究主要目的為評估全民健康保險糖尿病醫療給付改善方案對糖尿病病人因糖尿病慢性併發症之醫療資源利用的影響，醫療利用包括門診與住院的費用及次數。
方法
本研究為回溯性縱貫性研究(retrospective longitudinal study)，研究期間為2000年到2004年五年，資料來源為全民健康保險研究資料庫(National Health Insurance Research Database)的次級資料，研究對象為2000、2001年資料庫中糖尿病病人，在2002年1月到2003年12月期間，加入「全民健康保險糖尿病醫療給付改善方案」者作為實驗組(experimental group)，在針對性別、年齡、就醫醫院層級別進行一對一匹配(matching)未參加此方案的糖尿病病人作為比較組(comparison group)。二組人數相同，比較兩組糖尿病病人在方案介入前後，糖尿病慢性併發症之門診與住院的費用及次數之差異。 是採類實驗設計(quasi-experimental design)，以重複量數雙因子變異數分析(repeated measures two-way ANOVA)對實驗組與比較組進行「全民健康保險糖尿病醫療給付改善方案」介入前、後測分析(the nonequivalent comparison group, pretest-posttest analysis)
結果
實驗組與比較組各484人，二組男性都226人，平均年齡皆為57.27歲；女性都是258人，平均年齡皆為58.87歲。
在本研究中所列出的 8 種糖尿病慢性併發症費用，經重複量數雙因子變異數分析(repeated measures two-way ANOVA)的結果，發現心血管併發症門診費用在方案介入前後，比較組費用的增加幅度，顯著高於實驗組。而神經併發症、腦血管併發症、週邊血管併發症、腎臟併發症、內分泌/代謝併發症和眼睛併發症的費用在方案介入前後，則沒有顯著差異。至於其他併發症門診費用與住院費用，實驗組費用的增加幅度，顯著高於比較組。兩組在方案介入前後，八類併發症門診、住院次數的增加幅度，實驗組顯著高於比較組。此外，實驗組與比較組在2001 ~ 2004年間，因腦血管併發症或心血管併發症於住院期間死亡之醫療費用，沒有顯著差異。

結論與建議
糖尿病醫療費用逐年攀升的趨勢仍持續進行，建議衛生政策制定者持續施行「全民健康保險醫療給付改善方案」，分析相關糖尿病照護指標與評估糖尿病併發症管理的成效，提供病人包含診察、檢驗、衛教及追蹤等完整的服務，不只是控制血糖，也要控制血壓、血脂等危險因子，並加強感染症預防的衛教，減少併發症，落實健康生活。

Objective
The research was to evaluate the effect of the National Health Insurance Improvement Plan for
Diabetes Medical Benefits on medical utilization of the diabetic patients. The medical
utilization included the annual outpatient visits, cost of outpatient, frequency of admission,
and cost of admission.
Methods
We conducted a retrospective longitudinal study, analyzing the data of diabetic patients in
2000-2004, retrieved from the Registry for Beneficiaries from National Health Insurance
Research Database. The experimental group was defined as diabetic patients joining the
National Health Insurance Improvement Plan for Diabetes Medical Benefits from January,2002
to December,2003. The comparison group was extracted diabetic patients never joining the
above plan with their age,sex,and hospital rank matched control from the database of Registry
for Beneficiaries. The quasi-experimental design ( nonequivalent comparison group, pretest-
posttest analysis) was conducted and the repeated measures two-way ANOVA was used to
analyse the medical utilization ( numbers of outpatient visits and hospitalization ) and
medical expenditure ( outpatient and hospitalization service expenditure ) of the chronic
diabetic complications of the two groups.
Results
There were 226 men with mean age of 57.27 years old and 258 women with mean age of 58.87
years old in the experimental group and comparison group individually.
There was statistically significant increase of outpatient service expenditure of
cardiovascular complication in the comparison group. But there was statistically
significant increase of outpatient and hospitalization service expenditure of other
complication ( except complications of neurological symptoms, cerebral vascular disease,
peripheral vascular disease, cardiovascular disease,renal disease, endocrine/metabolic disease,
and ophthalmic disease ) in the experimental group. The statistically significant increase of
numbers of outpatient visits and hospitalization for chronic diabetic complications was
found also by he repeated measures two-way ANOVA. In addition, there was not statistically
significant difference in medical expenditure of fatal cerebral vascular disease and fatal
cardiovascular disease between the experimental and comparison groups.
Conclusions and Advisements
The healthcare costs of diabetes-related complications have been soaring year by year. To keep
the National Health Insurance Improvement Plan for Diabetes Medical Benefits going on is
recommended. It is necessary to evaluate the relevant targets of diabetic health care and the
effect of managing complications resulting from diabetes. The intact health care service for
diabetic patients includes physical examination , laboratory evaluation , diabetes self-
management education and clinical follow-up , not only to control the blood sugar but also
to control other risk factors , such as hypertension and hyperlipidemia,etc..
In addition,to enhance educating diabetic patients how to prevent infective disease will reduce
the complication and implement healthy life.

目錄
致 謝.............................................................................................................I
摘 要.............................................................................................................II
ABSTRACT..................................................................................................IV
目 錄.............................................................................................................VI
表目錄...........................................................................................................VII
圖目錄...........................................................................................................VIII
第一章 緒 論
第一節 研究背景與動機...................................................................1
第二節 研究目的...............................................................................5
第三節 預期貢獻...............................................................................6
第四節 名詞解釋...............................................................................7
第二章 文獻探討
第一節 糖尿病的定義、診斷、分類與盛行率...............................8
第二節 全民健康保險糖尿病醫療給付改善方案..........................11
第三節 糖尿病相關併發症種類......................................................13
第四節 糖尿病及相關併發症之醫療資源利用
與糖尿病個案管理的效益..................................................15
第三章 材料與方法
第一節 研究概念架構和研究假設..................................................17
第二節 研究設計..............................................................................20
第三節 研究樣本與資料來源..........................................................21
第四節 研究變項..............................................................................23
第五節 統計分析..............................................................................24
第四章 結 果
第一節 研究樣本基本資料統計分析結果......................................25
第二節 兩組糖尿病病人，在方案介入前後，糖尿病
慢性併發症之門診與住院費用及次數之差異..................27
第三節 兩組糖尿病病人，因腦血管併發症或心血管
併發症於住院期間死亡的費用之差異..............................48
第五章 討 論
第一節 研究結果與相關文獻討論..................................................49
第二節 研究限制及未來研究方向..................................................53
第六章 結論與建議
第一節 結論......................................................................................55
第二節 建議......................................................................................56
參考文獻......................................................................................................58
附錄..............................................................................................................64

表目錄

表 2-1 診斷糖尿病及其他高血糖類型的數值..................................................9
表 2-2 全民健康保險糖尿病醫療給付改善方案支付標準............................12
表 4-1 研究樣本人口學特質............................................................................26
表 4-2 研究樣本就醫醫院層級別....................................................................26
表 4-3 兩組在方案介入前後，神經併發症門診費用分析............................27
表 4-4 兩組在方案介入前後，神經併發症住院費用分析............................28
表 4-5 兩組在方案介入前後，腦血管併發症門診費用分析........................29
表 4-6 兩組在方案介入前後，腦血管併發症住院費用分析........................30
表 4-7 兩組在方案介入前後，周邊血管併發症門診費用分析....................31
表 4-8 兩組在方案介入前後，周邊血管併發症住院費用分析....................32
表 4-9 兩組在方案介入前後，心血管併發症門診費用分析........................33
表 4-10 兩組在方案介入前後，心血管併發症住院費用分析........................34
表 4-11 兩組在方案介入前後，腎臟併發症門診費用分析............................35
表 4-12 兩組在方案介入前後，腎臟併發症住院費用分析............................36
表 4-13 兩組在方案介入前後，內分泌/代謝併發症門診費用分析...............37
表 4-14 兩組在方案介入前後，眼睛併發症門診費用分析............................38
表 4-15 兩組在方案介入前後，眼睛併發症住院費用分析............................39
表 4-16 兩組在方案介入前後，其他併發症門診費用分析............................40
表 4-17 兩組在方案介入前後，其他併發症住院費用分析............................41
表 4-18 兩組在方案介入前後，八類併發症門診費用總和分析....................42
表 4-19 兩組在方案介入前後，八類併發症住院費用總和分析....................43
表 4-20 兩組在方案介入前後，八類併發症醫療費用總和分析....................44
表 4-21 兩組在方案介入前後，醫療費用的變化經由重複量數變異數分析
的結果....................................................................................................45
表 4-22 兩組在方案介入前後，八類併發症門診次數分析.............................46
表 4-23 兩組在方案介入前後，八類併發症住院次數分析..............................47
表 4-24 兩組病人因腦血管併發症或心血管併發症於住院期間死亡
的費用之差異........................................................................................48









圖目錄

圖 3-1 研究概念架構圖..................................................................................17
圖 4-1 神經併發症門診費用分析之剖面圖..................................................27
圖 4-2 神經併發症住院費用分析之剖面圖..................................................28
圖 4-3 腦血管併發症門診費用分析之剖面圖..............................................29
圖 4-4 腦血管併發症住院費用分析之剖面圖..............................................30
圖 4-5 周邊血管併發症門診費用分析之剖面圖..........................................31
圖 4-6 周邊血管併發症住院費用分析之剖面圖..........................................32
圖 4-7 心血管併發症門診費用分析之剖面圖..............................................33
圖 4-8 心血管併發症住院費用分析之剖面圖..............................................34
圖 4-9 腎臟併發症門診費用分析之剖面圖..................................................35
圖 4-10 腎臟併發症住院費用分析之剖面圖..................................................36
圖 4-11 內分泌/代謝併發症門診費用分析之剖面圖.....................................37
圖 4-12 眼睛併發症門診費用分析之剖面圖..................................................38
圖 4-13 眼睛併發症住院費用分析之剖面圖..................................................39
圖 4-14 其他併發症門診費用分析之剖面圖..................................................40
圖 4-15 其他併發症住院費用分析之剖面圖..................................................41
圖 4-16 八類併發症門診費用總和分析之剖面圖..........................................42
圖 4-17 八類併發症住院費用總和分析之剖面圖..........................................43
圖 4-18 八類併發症醫療費用總和分析之剖面圖..........................................44
圖 4-19 八類併發症門診次數分析之剖面圖..................................................46
圖 4-20八類併發症住院次數分析之剖面圖...................................................47

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