跳到主要內容

臺灣博碩士論文加值系統

(3.95.131.146) 您好!臺灣時間:2021/07/26 04:28
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

我願授權國圖
: 
twitterline
研究生:簡湘庭
研究生(外文):Hsiang-Ting Chien
論文名稱:骨關節炎患者中西醫門診醫療利用情形及其相關因素-以2004-2005年承保抽樣歸人檔為例
論文名稱(外文):Health Services Utilization of Western and Traditional Chinese Medicine by Osteoarthritis Patients and its Relative Factors—Using the Panel Claims Data of National Health Insurance Beneficiaries of 2004 and 2005 as an Example
指導教授:楊銘欽楊銘欽引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:醫療機構管理研究所
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:2009
畢業學年度:97
語文別:中文
論文頁數:110
中文關鍵詞:骨關節炎健康保險門診醫療利用醫療費用中醫西醫中西醫併用
外文關鍵詞:OsteoarthritisNational Health Insurancehealth services utilization ambulatory caremedical expensesChinese medicineWestern medicineChinese and Western medicine
相關次數:
  • 被引用被引用:10
  • 點閱點閱:364
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:3
研究背景與目的:骨關節炎為一常見關節疾病,加上現時就醫模式多樣性,病人除西醫外還可選擇傳統中醫、中西醫併用等就醫模式,造成病人有複向醫療利用的現象。本研究主要目的在探討全民健康保險資料庫「骨關節炎病患」中醫、西醫及中西醫併用之醫療利用情形及其影響因素。
研究方法:研究資料乃利用2004-2005年全民健康保險資料之「門診處方及治療明細檔」之承保抽樣歸人檔第一組至第四組,擷取ICD-9-CM前三碼為715之病人為研究對象,將每筆人依首次就醫日往後追蹤一年,刪除大於一年資料,共3,841人,將其分為西醫、中醫、中西醫併用三組,分別為3,714人、67人、60人。以t檢定及變異數分析(Analysis of Variance, ANOVA)檢定資源耗用之差異,並採用逐步迴歸統計方法探討門診病人之中醫、西醫、中西醫併用治療之歸戶醫療資源利用情形與其影響因素。
研究結果:骨關節炎歸戶就醫部份,西醫門急診佔96.69%,中醫門診佔1.74%,中西醫併用佔約1.56%。病人特質方面,以女性居多,年齡為40-49歲、50-59歲、60-69歲最多;就醫時常見有合併或併發退化性脊椎炎及有關疾患者、合併軟組織之其他疾患、其他及未明示之背部疾患;西醫以就醫場所為私立、基層院所、台北分局居多;中醫歸戶就醫病人方面,權屬別以公立、基層院所、台北分局為主;中西醫併用歸戶就醫,以財團法人、基層院所、台北分局所轄範圍佔絕大多數。醫療利用方面,西醫歸人後門急診累計醫療費用平均值6,965.41點/人,累計就醫次數為6.33次/人,累計給藥日份平均80.55天/人。中醫歸人部份,累醫療費用平均值3,883.51點/人,累計就醫次數平均為4.93次/人,累計給藥日份平均為48.1天/人。中西醫併用歸人就醫記錄中,門急診累醫療費用平均8,132.72點/人,累計就醫次數平均為8.38次/人,累計給藥日份平均為95.13天/人。
從迴歸模式得知,骨關節炎病患就醫部份,西醫門急診累計醫療費用、累計給藥日份、累計就醫次數與性別、年齡、是否免部份負擔、合併症與併發症有顯著關係;中醫門診累計醫療費用、累計給藥日份與合併症與併發症有顯著關係,而累計給藥日份、累計就醫次數與健保分局別有顯著關係;中西醫併用門診累計醫療費用與性別、健保分局別有關,累計就醫次數及累計給藥日份與權屬別有顯著關係,病人採用西醫、中醫、中西醫併用之就醫模式與累計醫療費用、累計就醫次數有顯著關係。
研究結論:研究發現骨關節炎病患之性別、年齡、部份負擔、合併症/併發症及醫事機構權屬別、特約層級、健保分局別,皆會影響西醫、中醫、中西醫併用之醫療利用。
Background and objectives: Osteoarthritis (OA) is the most common arthritis disease and there are various services nowadays. People can choose traditional Chinese medicine besides wstern medicine, which results in health services utilization of plural care phenomena. The purposes of this study were to explore health services utilization of western and traditional Chinese medicine by osteoarthritis patients under the National Health Insurance and its related factors.
Method: The source of the data came from claims data of the first to fourth sets of sampled registry of beneficiaries of National Health Insurance of 2004 and 2005. ICD-9-CM with initial three codes as 715 were selected from the panel database. Cases were traced for one year after the first visit in the claims file. A total of 3,841 patients were identified and divided into three groups, namely western medicine care group, Chinese medicine care group, and Chinese and western medicine care group. There were 3,714 patients in western medicine care group, 67 in Chinese medicine care group, and 60 in Chinese and western medicine care group. Data were analyzed by using student’s t test and Analysis of Variance (ANOVA). Stepwise regression analysis was used to explore health services utilization of western and traditional Chinese medicine and its related factors.
Result: The proportion of patients using western medicine ambulatory care and emergency, Chinese medicine ambulatory care, Chinese and Western medicine ambulatory care and emergency were 96.69%, 1.74%, and 1.56%, respectively. In terms of patient characteristics, patients tended to be female, aged 40-49, 50-59 and 60-69 years old, with comobidity or complications of Spondylosis and allied disorders and Other disorders of soft tissues, other and unspecified disorders of back. For western medicine ambulatory care and emergency, the majority of patients received care from private hospitals, clinics, Taipei Branch. In accordance with Chinese medicine ambulatory care, people received care from public, clinics, Taipei Branch were in the majority. In personal visit of Chinese and Western medicine care, people received care from non-profit proprietary hospitals, clinics, Taipei Branch were in the majority.
In terms of health services utilization patterns, the average accumulative medical expenses, accumulative days of prescription, accumulative number of visit for western medicine ambulatory care, were 6,965.41 points per person, 6.33 times, 80.55 days; for Chinese medicine ambulatory 3,883.51 points per person, 4.93 times, 48.1 days; and for Chinese and Western medicine ambulatory care 8,132.72 points per person, 8.38 times, 95.13 days.
Multiple regression results indicate that osteoarthritis personal visit, ambulatory and emergency care accumulative expenses per patient visit for Western medicine, days of prescription, accumulative visit times were significantly related to gender, age, comobidities and complication, whether or not have to pay copayment.
The accumulative expenses of Chinese medicine visits, days of prescription were significantly related to comobidities and complication, and days of prescription. Accumulative visit times were related to visiting place; ambulatory and emergency care.
Accumulative expenses per patient visit for Chinese and Western medicine was significantly related to sex, visiting place. Accumulative visit times and days of prescription were significantly related to ownership of provider. Patients medical treatment models of Western medicine care, Chinese medicine care and Chinese/Western medicine care were significantly related to the accumulative medical expenses and accumulative visit times.
Conclusion:
This study found that gender, age, copayment status, comobiditries/complication, ownership of provider, contracted category and visiting place of osteoarthritis patients were significantly related to the medical utilization of Western medicine care, Chinese medicine care and Chinese/Western medicine care.
目錄
口試委員會審定書 I
誌謝 II
中文摘要 III
Abstract V
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 4
第二章 文獻探討 5
第一節 骨關節炎流行病學及定義 5
第二節 醫療服務利用模式 9
第三節 罹病成本 11
第四節 相關實證研究 13
第五節 綜合討論 17
第三章 研究材料與方法 21
第一節 研究架構 21
第二節 研究流程 22
第三節 研究假說 23
第四節 研究變項 24
第五節 研究材料 28
第六節 資料處理與統計分析 32
第四章 研究分析與結果 34
第一節 描述性統計分析 34
第二節 推論性統計分析 37
第五章 討論 95
第一節 重要研究結果之討論 95
第二節 研究限制 101
第六章 結論與建議 102
第一節 結論 102
第二節 建議 105
參考文獻 106
英文文獻 106
中文文獻 109


圖目錄
圖1-1 民國95年骨關節炎醫療費用(點數)統計-依年齡別分 2
圖1-2民國95年骨骼肌肉系統及結締組織之疾病門診醫療費用統計-按疾病別及院所分 2
圖2-1第一階段醫療服務利用行為模式(1960s) 10
圖3-1研究架構一 21
圖3-2研究架構二 21
圖3-3研究流程 22
圖4-1西醫、中醫、中西醫併用人數圓餅圖 52
圖4-2骨關節炎西醫門急診年齡分佈 92
圖4-3骨關節炎中醫門診年齡分佈 92
圖4-4骨關節炎中西醫門急診年齡分佈 92

表目錄
表2-1骨關節炎之醫療利用與罹病成本相關研究整理 18
表3-1變項操作型定義 26
表3-2資料處理過程 29
表4-1骨關節炎西醫歸戶就醫之病人特質描述性統計,2004-2005 46
表4-2骨關節炎西醫歸戶就醫之就醫場所特質描述性統計,2004-2005 47
表4-3骨關節炎中醫歸戶就醫之病人特質描述性統計,2004-2005 48
表4-4骨關節炎中醫歸戶就醫之就醫場所特質描述性統計,2004-2005 49
表4-5骨關節炎中西醫併用歸戶就醫之病人特質描述性統計,2004-2005 50
表4-6骨關節炎中西醫併用歸戶就醫之就醫場所特質描述性統計,2004-2005 51
表4-7西醫、中醫、中西醫併用骨關節炎門急診歸戶就醫之醫療服務利用描述性統計,2004-2005 52
表4-8骨關節炎西醫歸戶就醫之病人特質與西醫門急診累計醫療費用之檢定,2004-2005 53
表4-9骨關節炎西醫歸戶就醫之就醫場所特質與西醫門急診累計醫療費用之檢定,2004-2005 54
表4-10骨關節炎西醫歸戶就醫之病人特質與西醫門急診累計給藥日份之檢定,2004-2005 55
表4-11骨關節炎西醫歸戶就醫之就醫場所特質與西醫門急診累計給藥日份之檢定,2004-2005 56
表4-12骨關節炎西醫歸戶就醫之病人特質與西醫門急診累計就醫次數之檢定,2004-2005 57
表4-13骨關節炎西醫歸戶就醫之就醫場所特質與西醫門急診累計就醫次數之檢定,2004-2005 58
表4-14骨關節炎中醫歸戶就醫之病人特質與中醫門診累計醫療費用之檢定,2004-2005 59
表4-15骨關節炎中醫歸戶就醫之就醫場所特質與中醫門診累計醫療費用之檢定,2004-2005 60
表4-16骨關節炎中醫歸戶就醫之病人特質與中醫門診累計給藥日份之檢定,2004-2005 61
表4-17骨關節炎中醫歸戶就醫之就醫場所特質與中醫門診累計給藥日份之檢定,2004-2005 62
表4-18骨關節炎中醫歸戶就醫之病人特質與中醫門診累計就醫次數之檢定,2004-2005 63
表4-19骨關節炎中醫歸戶就醫之就醫場所特質與中醫門診累計就醫次數之檢定,2004-2005 64
表4-20骨關節炎中西醫歸戶就醫之病人特質與中西醫門診累計醫療費用之檢定,2004-2005 65
表4-21骨關節炎中西醫歸戶就醫之就醫場所特質與中西醫門診累計醫療費用之檢定,2004-2005 66
表4-22骨關節炎中西醫歸戶就醫之病人特質與中西醫門診累計給藥日份之檢定,2004-2005 67
表4-23骨關節炎中西醫歸戶就醫之就醫場所特質與中西醫門診累計給藥日份之檢定,2004-2005 68
表4-24骨關節炎中西醫歸戶就醫之病人特質與中西醫門診累計就醫次數之檢定,2004-2005 69
表4-25骨關節炎中西醫歸戶就醫之就醫場所特質與中西醫門診累計就醫次數之檢定,2004-2005 70
表4-26骨關節炎病人歸戶採行中醫、西醫、中西醫併用之不同就醫模式與門急診累計醫療費用之檢定結果,2004-2005 71
表4-27骨關節炎病人歸戶採行中醫、西醫、中西醫併用之不同就醫模式與累計就醫次數之檢定,2004-2005 71
表4-28骨關節炎病人歸戶採行中醫、西醫、中西醫併用之不同就醫模式與累計給藥日份之檢定,2004-2005 71
表4-29骨關節炎門急診歸戶病人特質與就醫模式之檢定 72
表4-30骨關節炎西醫門急診複迴歸虛擬變項設定表 75
表4-31骨關節炎中醫門診複迴歸虛擬變項設定表 77
表4-32骨關節炎中西醫併用門急診複迴歸虛擬變項設定表 78
表4-33骨關節炎西醫、中醫、中西醫併用門急診複迴歸虛擬變項設定表 79
表4-34病人特質、就醫場所特質與西醫門急診累計醫療費用對數值之逐步迴歸分析 81
表4-35病人特質、就醫場所特質與西醫門急診累計就醫次數對數值之逐步迴歸分析 83
表4-36病人特質、就醫場所特質與西醫門急診累計給藥日份對數值之逐步迴歸分析 84
表4-37病人特質、就醫場所特質與中醫門診累計醫療費用對數值之逐步迴歸分析 85
表4-38病人特質、就醫場所特質與中醫門診累計就醫次數對數值之逐步迴歸分析 85
表4-39病人特質、就醫場所特質與中醫門診累計給藥日份對數值之逐步迴歸分析 86
表4-40病人特質、就醫場所特質與中西醫門急診累計醫療費用對數值之逐步迴歸分析 86
表4-41病人特質、就醫場所特質與中西醫門急診累計就醫次數對數值之逐步迴歸分析 87
表4-42病人特質、就醫場所特質與中西醫門急診累計給藥日份對數值之逐步迴歸分析 87
表4-43骨關節炎歸戶病人不同就醫模式與門急診累計醫療費用對數值之逐步迴歸分析 88
表4-44骨關節炎歸戶病人不同就醫模式與門急診累計就醫次數對數值之逐步迴歸分析 90
表4-45骨關節炎歸戶病人不同就醫模式與門急診累計給藥日份對數值之逐步迴歸分析 93
Altman RD. Overview of osteoarthritis. Am J Med 1987;83:65-9.
Altman RD. Criteria for classification of clinical osteoarthritis. In: 2nd Symp on Osteoarthritis : Update on Diagnosis and Therapy; 1990 Oct 02-05; Val David, Canada: J Rheumatol Publ Co; 1990. p. 10-2.
Amin S, Goggins J, Niu J, et al. Occupation-related squatting, kneeling, and heavy lifting and the knee joint: A magnetic resonance imaging-based study in men. Journal of Rheumatology 2008;35:1645-9.
Andersen RM. Revisiting the behavioral-model and access to medical-care-does it matter. J Health Soc Behav 1995;36:1-10.
Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Acupuncture effective for osteoarthritis of the knee. J Fam Pract 2005;54:200-.
Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications. Curr Opin Rheumatol 2002;14:573-7.
Coupe VMH, Veenhof C, van Tulder MW, Dekker J, Bijlsma JWJ, Van den Ende CHM. The cost effectiveness of behavioural graded activity in patients with osteoarthritis of hip and/or knee. Annals Of The Rheumatic Diseases 2007;66:215-21.
Drummond MF, Richardson WS, Obrien BJ, Levine M, Heyland D. Users'' guides to the medical literature .13. How to use an article on economic analysts of clinical practice .A. Are the results of the study valid? JAMA-J Am Med Assoc 1997;277:1552-7.
Druss BG, Rosenheck RA. Association between use of unconventional therapies and conventional medical services. JAMA-J Am Med Assoc 1999;282:651-6.
Easton BT. Evaluation and treatment of the patient with osteoarthritis. J Fam Pract 2001;50:791-7.
Engelhardt M. Epidemiology of osteoarthritis in Western Europe. Dtsch Z Sportmed 2003;54:171-5.
Gignac MAM, Backman CL, Davis AM, et al. Understanding social role participation: What matters to people with arthritis? Journal of Rheumatology 2008;35:1655-63.
Gupta S, Hawker GA, Laporte A, Croxford R, Coyte PC. The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology 2005;44:1531-7.
Hawkey C, Kahan A, Steinbruck K, et al. Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients (vol 37, pg 937, 1998). Br J Rheumatol 1998;37:1142-.
Lapsley HM, March LM, Tribe KL, Cross MJ, Brooks PM. Living with osteoarthritis: Patient expenditures, health status, and social impact. Arthritis Rheum-Arthritis Care Res 2001;45:301-6.
Le Pen C, Reygrobellet C, Gerentes I. The coart study: The cost of osteoarthritis in France between 1991 and 2002. Value in Health 2004;7:661-2.
Le Pen C, Reygrobellet C, Gerentes I. Financial cost of osteoarthritis in France - The "COART"'' France study. Joint Bone Spine 2005;72:567-70.
Leardini G, Salaffi F, Caporali R, Canesi B, Rovati L, Montanelli R. Direct and indirect costs of osteoarthritis of the knee. Clin Exp Rheumatol 2004;22:699-706.
Levy E, Ferme A, Perocheau D, Bono I. Social and economic-aspects of osteoarthritis in France. Rev Rhum 1993;60:S63-S7.
Liedgens H, Nuijten MJC, Nautrup BP. Economic evaluation of tramadol/paracetamol combination tablets for osteoarthritis pain in the Netherlands. Clinical Drug Investigation 2005;25:785-802.
Maetzel A, Li LC, Pencharz J, Tomlinson G, Bombardier C. The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Annals Of The Rheumatic Diseases 2004;63:395-401.
March LM, Bachmeier CJM. Economics of osteoarthritis: a global perspective. Baillieres Clin Rheumatol 1997;11:817-34.
Nguyen M, Revel M, Dougados M. Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: Follow-up after 6 months. A randomized controlled trial. Br J Rheumatol 1997;36:77-81.
O''Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Annals Of The Rheumatic Diseases 1999;58:15-9.
Ramsey SD, Spencer AC, Topolski TD, Belza B, Patrick DL. Use of alternative therapies by older adults with osteoarthritis. Arthritis Rheum-Arthritis Care Res 2001;45:222-7.
Rao JK, Kroenke K, Mihaliak KA, Grambow SC, Weinberger M. Rheumatology patients'' use of complementary therapies: Results from a one-year longitudinal study. Arthritis Rheum-Arthritis Care Res 2003;49:619-25.
Richardson G, Hawkins N, McCarthy CJ, et al. Cost-effectiveness of a supplementary class-based exercise program in the treatment of knee osteoarthritis. International Journal of Technology Assessment in Health Care 2006;22:84-9.
Rosemann T, Grol R, Herman K, Wensing M, Szecsenyi J. Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis. Int J Behav Nutr Phys Act 2008;5:8.
Rosemann T, Joos S, Szecsenyi J, Laux G, Wensing M. Health service utilization patterns of primary care patients with osteoarthritis. BMC Health Serv Res 2007;7:8.
Shen C, Sambamoorthi U, Rust G. Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness. Dis Manag 2008;11:153-60.
Williamson L, Wyatt MR, Yein K, Melton JTK. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford, England) 2007;46:1445-9.
Willich SN, Reinhold T, Selim D, Jena S, Brinkhaus B, Witt CM. Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain 2006;125:107-13.
Woo J, Lau E, Lau CS, et al. Socioeconomic impact of osteoarthritis in Hong Kong: Utilization of health and social services, and direct and indirect costs. Arthritis Rheum-Arthritis Care Res 2003;49:526-34.
Xie F, Thumboo J, Li SC. True difference or something else? Problems in cost of osteoarthritis studies. Semin Arthritis Rheum 2007;37:127-32.
Yelin E, Murphy L, Cisternas MG, Foreman AJ, Pasta DJ, Helmick CG. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997. Arthritis Rheum 2007;56:1397-407.
Yen ZS, Lai MS, Wang CT, et al. Cost-effectiveness of treatment strategies for osteoarthritis of the knee in Taiwan. Journal of Rheumatology 2004;31:1797-803.
Zhang JX, Woo J, Lau WCS, Lee P, Chiu P, Lam D. Effects of use of alternative therapies on quality of life and healthcare spending. Am J Chin Med 2007;35:183-93.
中文文獻
王廷輔:台中地區居民中西醫療行為取向之研究。公共衛生1990;17:21-33。
行政院衛生署全民健康保險爭議審議委員會電子報:單腔人工膝關節置換手術適應症之爭議。http://www.dmc.doh.gov.tw/dmc_historyEpaper/%B2%C4%A4Q%B4%C1%B9q%A4l%B3%F8.htm引用2008/11/11。
吳就君:台灣地區居民社會醫療行為研究。公共衛生1981;8:25-49。
李丞華、周穎政、陳龍生、張鴻仁:全民健保中醫門診利用率及其影響因素。台灣公共衛生雜誌 2004;23:100-7。
林怡賓:退化性關節炎。北市中醫會刊2003:21-6。
林致坊:全民健康保險北區分局中醫門診利用之研究。台北:國立陽明大學衛生福利研究所碩士論文,1998。
邱詩淵:退化性關節炎。http://homepage.vghtpe.gov.tw/~fm/patedu/96_4。引用2008/3/11。
莊媄婷:以全民健保1996-2001年承保抽樣歸人檔分析下背痛病人之醫療利用。台北:國立台灣大學醫療機構管理研究所碩士論文,2004。
陳文寧:纖維肌痛症後群(Fibromyalgia)。屏基藥訊 2004:3。
陳朝宗:針刺治療對膝退化性關節炎疼痛評估之預試驗。中醫骨傷科醫學雜誌2005:7-11。
陳育群:利用關聯規則探討醫學中心門診病患試醫行為。台北:國立陽明大學衛生資訊與決策研究所碩士論文,2002。
陳渼雅:以全民健保2000-2003年承保抽樣歸人檔分析過敏性鼻炎患者之醫療利用情形及其相關因素。台北:國立台灣大學醫療機構管理研究所碩士論文,2005。
郭巧儀:多醫就診之醫療利用及其影響因素。台北:國立陽明大學醫務管理研究所碩士論文,2004。
郭德貞,李玉春,陳星助:台灣更年期婦女中西醫門診利用型態之分析:1997-2004。健康保險期刊 2007;4:1-13。
陳潮宗:骨關節炎(Osteoarthritis)外治概述。http://www.drchen.com.tw/healthy_medicine_center/038.htm。引用2009 /1/6。
蔡瓊玉:全民健保脫臼扭傷拉傷患者中西醫門診醫療利用情形之探討-以健保局 中區分局為例。台中:私立中國醫藥大學醫務管理研究所碩士論文,2005。
盧樹森:中醫傷科手法對骨性膝關節炎療效之評估。台中:私立中國醫藥大學中西醫結合研究所碩士論文,2001。
謝春福:醫療給付效益提昇計劃前後馬祖地區民眾醫療利用與費用之分析。台北:國立台灣大學醫療機構管理研究所碩士論文,2004。
羅賢益:全人工髖關節及膝關節置術服務量與結果之關連性探討。台北:國立台灣大學醫療機構管理研究所碩士論文,2005。
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top