台灣2005-2008年肥胖病患住院特性及醫療費用的影響因子

Obesity Inpatients in Taiwan: Characteristics and Medical Utilization Factors during 2005-2008

呂俞樺(Yu-Hua Lu) ； 白璐(Lu Pai) ； 林金定(Jin-Ding Lin) ； 祝年豐(Nian-Feng Chu) ； 簡戊鑑(Wu-Chien Chien)

《醫護科技期刊》 13卷2期 (2011/06) Pp. 76-88

https://doi.org/10.6563/TJHS.2011.13(2).2

摘要

目的：瞭解肥胖住院病患的就醫特性，找出肥胖住院病患醫療費用的影響因子。方法：使用2005-2008年全民健保資料庫，「住院醫療費用清單明細檔(DD)」與「醫事機構基本資料檔(HOSB)」，選取ICD-9-CM中N Code爲278、278.0、278.00、278.01及278.1之肥胖及其他營養過度的病患，排除分娩之孕婦，並以統計軟體SPSS 18.0進行分析。結果：台灣2005-2008年肥胖住院個案共7,814人次，男性爲3,542人次（約45.4%），女性爲4,272人次(54.6%)，平均年齡爲39歲，每人平均有2.74個共伴疾病，每次住院平均醫療費用爲54,139元，平均住院天數爲9.24天。病患就醫以區域醫院最多（男性44.7%，女性47.7%）。就醫科別，以一般外科最多，其次爲心血管內科、一般內科、小兒科、骨科、內分泌科等。肥胖者較常罹患的慢性病依序爲高血壓（2,397人次）、糖尿病（1,829人次）、高血脂（1,293人次）、周邊心血管疾病（576人次）。以羅吉斯迴歸分析顯示，女性（男性：OR=.751）、18歲以上（18-30歲：OR=2.138、31-44歲：OR=1.943、45-64歲：OR=1.555、65歲以上：OR=1.447）、罹患重大傷病者(OR=4.985)、至醫學中心住院(OR=1.376)、外科者（如一般外科OR=4.741、骨科OR=2.516及消化外科OR=4.824）、共伴疾病數越多(OR: 1.221-2.414)及有手術處置(OR=6.399)的肥胖住院病患醫療費用皆有較高的情形，整體模式解釋力爲50.6%。結論：本研究發現影響肥胖住院病患醫療費用的因素計有性別、年齡分組、重大傷病、就醫層級、就醫科別、高血壓、共伴疾病數及手術處置等。外科的肥胖住院病患醫療費用較高，尤其是一般外科及消化外科，且共伴疾病數越多者醫療費用較高，另外，超過一半的肥胖住院病患罹患慢性疾病，未來慢性疾病的盛行率可能會因爲肥胖者增加而上升，進而影響醫療費用。

關鍵字

肥胖 ； 醫療利用 ； 全民健保資料庫

並列摘要

Purposes: This study was designed to identify obesity inpatient characteristics related to medical utilization and factors related to inpatient medical cost. Methods: This research used Taiwan National Health Insurance data on ”inpatient expenditures by admissions (DD)” and ”registry for contracted medical facilities (HOSB)” for the years 2005 through 2008. Researchers analyzed data using SPSS 18.0 software and defined obesity cases using ICD-9-CM N Code 278, 278.0, 278.00, 278.01 and 278.1. Results: Obese hospitalization cases identified included 7,814 cases, 3,542 and 4,272 of which were male and female (45.4% and 54.6%), respectively. Case ages averaged 39 years; had an average of 2.74 other diseases; had average medical expenditures of NT$54,139; and had average hospital stays of 9.24 days. Most cases (male 44.7%, female 47.7%) received treatment at regional hospitals. The largest number of cases was registered in the surgery department, followed by cardiology, internal medicine, pediatrics, orthopedics and endocrinology. The most common chronic diseases diagnosed included hypertension (n=2,397), diabetes (n=1,829), hyperlipidemia (n=1,293), and peripheral cardiovascular disease (n=576). Factors found using multivariate logistic regression as associated with higher medical expenditures included being female (male: OR=.751), being an adult (18-30 years: OR=2.318, 31-44 years: OR=1.943, 45-64 years: OR=1.555, over 65 years: OR=1.447), having a catastrophic illness (OR=4.985), seeking treatment at a medical center (OR=1.376), registration in the surgery department (OR=4.741), orthopedics department registration (OR=2.516) or digestion surgical department (OR=4.824), high number of co-morbidities (OR=1.221-2.414), and surgeries, operations or treatments (OR=6.399). The explanation of the overall model was 50.6%. Conclusions: This study found gender, age group, catastrophic illness, hospital type, medical department, hypertension, number of co-morbidities and surgeries, operations or treatments as factors significantly associated with medical utilization. Average medical costs for cases registered for surgery were higher, especially in the general surgery and digestive surgery departments. More co-morbidities associated positively with medical costs. The future prevalence of chronic diseases may rise due to the increased prevalence of obesity, which can be expected to affect medical utilization costs. Therefore, it is important to explore effective preventive strategies for high-risk groups, especially hypertension.

並列關鍵字

Obesity ； medical utilization ； national health insurance database