The Association of Household Income, Healthcare Utilization, and Survival of Catastrophic Illnesses Patients: Using ESRD and Cancer as Examples

重大傷病患者家戶所得與醫療利用、存活狀況之相關—以末期腎臟病與癌症為例

魏璽倫(Shi-Lun Wei) ； 楊銘欽(Ming-Chin Yang)

《台灣公共衛生雜誌》 32卷4期 (2013/08) Pp. 331-345

https://doi.org/10.6288/TJPH2013-32-04-04

摘要

Objectives: To investigate the association of household income and healthcare utilization as well as survival status of patients with catastrophic illnesses under the NHI system in Taiwan. Methods: Data from the ”Survey of Family Income and Expenditure” (2003 to 2006) and the ”Registry of patients with catastrophic illness” were first linked to identify subjects. Patients with cancer or end stage renal disease (ESRD) holding only one NHI catastrophic illness card were included in this study. Information related to healthcare utilization was obtained from NHI claims data (2002 to 2007) and survival data was obtained from the ”National Registry of Deaths” (2003 to 2009). Negative binominal regression, multiple regression, and the Cox proportional hazard model were used to analyze the relationships among healthcare utilization, survival, and socioeconomic variables. Results: Regarding the healthcare utilization, the average length of stay (ALOS) of ESRD patients in the highest income bracket was 8.987 days longer than that of patients in the lowest bracket (p＜0.05). Hemodialysis usage, the number of outpatient visits and hospitalizations presented no correlation with household income. Among cancer patients in the highest income bracket, the IRRs of outpatient visits and hospitalization were 1.18 (p＜0.05) and 2.11 (p＜0.001), respectively. The ALOS of those in the highest income bracket was 11.36 days longer than that of patients in the lowest income bracket (p＜0.001). With respect to survival status, male ESRD patients had a higher mortality than females (HR=1.82, p＜0.05). Among cancer patients, being males (HR=1.66, p＜0.05) and in the highest income bracket had higher mortality (HR=1.6, p＜0.05), those with the highest education level had lower mortality (HR=0.52, p＜0.05). Conclusions: The relationship between household income and healthcare utilization varied according to type of diseases. Income level was positively associated with healthcare utilization among cancer patients while patients in the highest income bracket had higher mortality. But the association was not significant among ESRD patients. Future researchers can conduct further analyses on other catastrophic illnesses.

關鍵字

全民健康保險 ； 重大傷病 ； 家戶所得 ； 醫療利用 ； 存活狀況

並列摘要

Objectives: To investigate the association of household income and healthcare utilization as well as survival status of patients with catastrophic illnesses under the NHI system in Taiwan. Methods: Data from the ”Survey of Family Income and Expenditure” (2003 to 2006) and the ”Registry of patients with catastrophic illness” were first linked to identify subjects. Patients with cancer or end stage renal disease (ESRD) holding only one NHI catastrophic illness card were included in this study. Information related to healthcare utilization was obtained from NHI claims data (2002 to 2007) and survival data was obtained from the ”National Registry of Deaths” (2003 to 2009). Negative binominal regression, multiple regression, and the Cox proportional hazard model were used to analyze the relationships among healthcare utilization, survival, and socioeconomic variables. Results: Regarding the healthcare utilization, the average length of stay (ALOS) of ESRD patients in the highest income bracket was 8.987 days longer than that of patients in the lowest bracket (p＜0.05). Hemodialysis usage, the number of outpatient visits and hospitalizations presented no correlation with household income. Among cancer patients in the highest income bracket, the IRRs of outpatient visits and hospitalization were 1.18 (p＜0.05) and 2.11 (p＜0.001), respectively. The ALOS of those in the highest income bracket was 11.36 days longer than that of patients in the lowest income bracket (p＜0.001). With respect to survival status, male ESRD patients had a higher mortality than females (HR=1.82, p＜0.05). Among cancer patients, being males (HR=1.66, p＜0.05) and in the highest income bracket had higher mortality (HR=1.6, p＜0.05), those with the highest education level had lower mortality (HR=0.52, p＜0.05). Conclusions: The relationship between household income and healthcare utilization varied according to type of diseases. Income level was positively associated with healthcare utilization among cancer patients while patients in the highest income bracket had higher mortality. But the association was not significant among ESRD patients. Future researchers can conduct further analyses on other catastrophic illnesses.

並列關鍵字

National Health Insurance ； catastrophic illness ； household income ； healthcare utilization ； survival

參考文獻

Asada, Y.,Kephart, G.(2007).Equity in health services use and intensity of use in Canada.BMC Health Serv Res.7,41.

Regidor, E.,Martinez, D.,Calle, M.E.,Astasio, P.,Ortega, P.,Dominguez, V.(2008).Socioeconomic patterns in the use of public and private health services and equity in health care.BMC Health Serv Res.8,183.

van Doorslaer, E.,Wagstaff, A.,Calonge, S.(1992).Equity in the delivery of health care: some international comparisons.J Health Econ.11,389-411.

van Doorslaer, E.(ed.),Wagstaff, A.(ed.),Rutten, F.(ed.)(1993).Equity in the Finance and Delivery of Health Care: An International Perspective.Oxford:Oxford University Press.

Culyer, A.J.(ed.),Newhouse, J.P.(ed.)(2000).Handbook of Health Economics.Amsterdam:North-Holland.