某醫學中心家庭醫學科住院病患醫療費用之分析

Cost Analysis of Inpatient Care in Family Medicine Ward at a Medical Center

黃建勳(Chien-Hsun Huang) ； 黃國晉(Kuo-Chin Huang) ； 陳慶餘(Ching-Yu Chen) ； 梁繼權(Kai-Kuen Leung)

《台灣醫學》 9卷1期 (2005/01) Pp. 8-17

https://doi.org/10.6320/FJM.2005.9(1).02

摘要

國內目前對家庭醫學科病房住院醫療花費之研究闕如，而國外對住院病患疾病型態與醫療費用的相關研究也很有限。故本研究之目的在以醫學中心家庭醫學科病房爲例，調查疾病與醫療費用的相關情形，幷探討影響醫療費用的因素。研究樣本取自台大醫院家庭醫學部病房自1999年7月至2001年6月間的出入院資料，共計1,058人次。住院病患以女性稍多(53%)。平均年齡為58歲，45歲以上中老年人佔76.5%，小於18歲者僅有0.7%。每人平均診斷數3.6個，平均住院天數11天。住院主診斷以急性病症爲多，包括如蜂窩組織炎之軟組織感染(12.5%)、泌尿道感染(12.0%)及急性下呼吸道感染如肺炎等(8.3%)。每位住院病患「總費用」平均為35,817元，「總費用」與「住院天數」、「病房費」（佔29.2%）、「藥費」（佔26.0%）、「檢驗費」（佔17.2%）和「診察費」（佔9.0%）相關性較高。「總費用」中的「基本費用」（包括「病房費」和「診察費」，兩者皆論日計酬）和「主要變動費用」（包括「藥費」、「檢驗費」、「影像費」、「治療費」）兩者平均各占「總費用」的38%與53％。而「每日總費用」高於平均值（3,075元）的前五項疾病，包括膽石症或膽囊炎（4,410元）、良性腫瘤（4,072元）、慢性阻塞性肺疾病（3,610元）、惡性腫瘤（3,583元）、急性下呼吸道成染（3,355元），其「基本費用」都比平均值的38%低，而「主要變動費用」則比平均值的53%高。另外「藥費」佔「主要變動費用」50%以上者，幾乎都是急性感染性疾病，或慢性疾病但伴隨急性感染，根據推論可能與持續使用抗生素注射有關；而「檢驗費」與「影像費」總合超過「主要變動費用」50%者有良性腫瘤(92%)、惡性腫瘤(69%)、糖尿病(69%)等。故為節省醫療成本，可針對疾病類別著重抗生素的合理使用或避免非必要性的檢驗。此外，本研究發現住院l週者「每日檢驗費」和「每日影像費」最高，但住院2週者「每日藥費」和「每日治療費」較l週者高，結果兩者之「每日總費用」並無統計上差異。但住院2周以上者，以上四種費用都有上升的趨勢，從其醫療資源使用密度的增加，可推論出該病房病患延長住院乃因實際病情嚴重度的需要。

關鍵字

醫療費用 ； 住院病患 ； 家庭醫業

並列摘要

Inpatient care is a major part of medical expense in the National Health Insurance However, few studies explored the nature of medical costs empirically in our setting This study tried to analyze the costs of inpatient care in family medicine ward at a medical center We collected a total of 1,058 patients who admitted to a family medicine ward from July 1999 to June 2001 The most patients were older than 45 years (76.5%) with a mean age of 58±19 years The average length of stay was 11±8 days and an average of 3.6±1.8 diagnoses The major diagnoses for admission were as the followings acute diseases such as cellulites (12.5%), urinary tract infection (12.0%), low respiratory tract infection as pneumonia (8.3%) and diabetes mellitus (8.0%) The mean medical cost was $35,815 NTD The total cost of admission is highly correlated with costs of length of stay, accommodation, medications, laboratory tests and medical care (r=0.88, 0.89, 0.86, 0.72, 0.89 respectively). The total cost can be divided into two parts the first is ”basic cost” including costs of accommodation and medical care, which is affected by the length of stay (per diem), the second is ”ancillary cost” including costs of medications, laboratory tests, image studies and therapeutic procedures The ”ancillary cost” is affected by the quantity of the services For those diseases with higher daily cost, the structure of medical expense usually had a lower percentage of ”basic cost” and higher percentage of ”ancillary cost” In addition, medications contributed to more than 50% of the main ”ancillary cost” in acute infectious diseases or chronic diseases with acute infection, which is probably due to the use of antibiotics On the other hand, ”ancillary cost” of benign or malignant neoplasm had higher percentage of costs in laboratory and image studies In order to save inpatient medical costs, the reasonable use of antibiotics and avoiding unnecessary laboratory or image studies are a must.

並列關鍵字

medical costs ； inpatients ； family practice