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研究生:胡楠英
研究生(外文):Nan-Ying Hu
論文名稱:癌症住院病患死亡前使用安寧療護與否之醫療費用的比較分析
論文名稱(外文):A Comparison of Health Care Expenditure of Cancer Terminal Stage Care Between Hospice and Nonhospice Patients
指導教授:林佳靜林佳靜引用關係
指導教授(外文):Chia-Chin Lin
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
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:85
中文關鍵詞:癌症安寧療護醫療費用
外文關鍵詞:cancerhospiceexpenditures
相關次數:
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整個醫療體系中瀕死階段是屬於高成本的健康照護,癌症照護是屬於高醫療成本的,癌症為台灣十大死因之首,每年因癌症死亡的人數也逐年增加。本研究旨在探討癌末臨終期病患在最後一次住院時接受安寧療護或傳統照護其醫療費用之差異。
本研究對象為2005年1月1日至2007年12月31日期間,中央健保局住院醫療費用明細檔之系統抽樣中死亡樣本。病患依照護型態分成安寧療護與傳統照護兩組,分別串聯兩組健保住院費用檔與醫令檔,瞭解癌末臨終前醫療利用之現況並比較兩組醫療費用之差異。
研究結果顯示,2005 - 2007年癌症末期住院死亡病患總計2,813人,接受安寧療護共545人,接受傳統照護共2,268人。在控制了病患和醫療機構特質等影響因素後,整體的解釋力達62.6%,癌末病患在臨終期住在安寧病房的天數比傳統病房的天數少,使用安寧療護其醫療費用每人平均花費為NT$37,334,卻比使用傳統照護的醫療費用每人平均少27.1%。
整體而言,安寧療護確實有達到節省成本支出的成效,但是接受安寧療護的癌症末期病患的比率仍偏低。建議政府機關應支持安寧療護的發展,加強醫學教育及民眾教育,讓癌症末期病患在臨終期能接受較合宜的照護方式,且未增加健保醫療費用的支出。
Objective:The health policy analysis have noted the high cost of the care for the terminal stage patients, and that for the cancer patients is evenhigher. Cancer has become the leading cause of the death in Taiwan since 1982,and cancer deaths have significantly increased in recent years. The purpose of this study is to compare the expenditures of hospice and nonhospice cares of the terminal stage cancer patients.

Methods:The population of the study included all the 2,813 cancerous deaths in Taiwan between January and December, 2005-2007. The data released from the National Health Research Institutes for the inpatient expenditures by admission files were compared .The subjects were divided into twocategories, the hospice and nonhospice medical costs in the terminal stage cancer patients.

Results:Among the 2,813 cancer deaths, 545 of them chose hospice cares which made up 19.4% of the cases. The adjusted relationship between hospitalization costs and the use of hospice care. It can be seen from this analysis that 62.6 %. The study disclosed that the interval
ofhospice stay for the terminal cancer patient is shorter, but the cost
of the stay is cheaper, and is lesser by 27.1%.

Conclusion:We come to the conclusion that the hospice care for the terminal stage cancer patient has cost benefit. However, the acceptance rate is low which makes up only 19.4% of the case. We, therefore, suggest that the governmentally support in this very aspect is essential, as well as the development of hospice care for the terminal stage cancer patients.
目 錄
頁數
論文摘要 i
Abstract ii
目錄 iii
第一章 緒論 1
第一節 研究動機 1
第二節 研究的重要性 4
第三節 名詞定義 5
第四節 研究目的 6
第二章 文獻查證 7
第一節 台灣全民健康保險之發展 7
第二節 安寧療護之理念與現況 9
第三節 臨終期費用之相關文獻 12
第四節 安寧療護與醫療費用相關文獻探討 16
第三章 研究方法 22
第一節 研究架構 22
第二節 研究問題 23
第三節 研究材料與選樣流程 24
第四節 研究變項與操作型定義 27
第五節 資料處理與統計分析方法 30
第四章 研究結果 32
第一節 研究對項基本資料描述性統計分析 33
第二節 研究對象使用安寧療護與傳統照護之醫療費用分析結果 40
第三節 研究對象使用安寧療護與傳統照護之住院天數之差異 46
第四節 研究對象影響醫療費用之複迴歸分析結果 47
第五節 研究對象影響醫療費用之線性混合迴歸分析結果 53
第五章 討論 58
第一節 樣本特性 58
第二節 樣本特性與醫療費用分析 60
第三節 研究對象臨終期之住院天數分析 63
第四節 研究對象臨終期醫療費用迴歸分析 65
第六章 結論與建議 66
第一節 結論 66
第二節 建議 67
第三節 研究限制 69
參考文獻 70
參考文獻
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1. 李淑真、劉雪娥、蔡培葵、賴裕和(2003)•接受安寧住院療護期間主要照顧者生活品質的變化•安寧療護雜誌,8(3),259-269。
2. 李淑真、劉雪娥、蔡培葵、賴裕和(2003)•接受安寧住院療護期間主要照顧者生活品質的變化•安寧療護雜誌,8(3),259-269。
3. 杜明勳(1998)•安寧療護之緣起與發展•臨床醫學,42(6),392-396。
4. 杜明勳(1998)•安寧療護之緣起與發展•臨床醫學,42(6),392-396。
5. 巫雅菁(2000)•由「安寧緩和醫療條例」談臨終關懷及其諮商輔導•諮商與輔導,177,2-6。
6. 巫雅菁(2000)•由「安寧緩和醫療條例」談臨終關懷及其諮商輔導•諮商與輔導,177,2-6。
7. 羅紀琼、陸幼琴、賴美淑(1999)•住院安寧療護與傳統醫院照護之費用比較分析•公共衛生,25,225-31。
8. 羅紀琼、陸幼琴、賴美淑(1999)•住院安寧療護與傳統醫院照護之費用比較分析•公共衛生,25,225-31。
9. 劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義 (2006)•台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究•健康管理學刊,4(1),1-22。
10. 劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義 (2006)•台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究•健康管理學刊,4(1),1-22。
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