論質計酬支付對於糖尿病照護城鄉差距之影響

Impact of Pay for Performance on Rural-Urban Differences in Diabetes Care

李耿德(Keng-Te Lee)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2017年)

https://doi.org/10.6342/NTU201701510

摘要

研究背景：糖尿病列為我國十大死因中第五名，為使照護結果提升，我國於西元2001年推動「全民健康保險糖尿病醫療給付改善方案」藉具有誘因的支付制度，期許能為糖尿病病患獲得持續且完整的照護。目前國內針對該改善方案之研究，較少探討對於照護利用及照護結果之影響，是否因城鄉不同而有不同。
研究目的：探討「全民健康保險糖尿病醫療給付改善方案」的推動，在論質計酬計畫下，糖尿病患者是否因為城鄉差距的存在，因方案的介入而有不同的照護利用及結果。
研究方法：本研究透過全民健康保險研究資料庫百萬歸人檔進行資料分析，以2005年之糖尿病患者為研究對象。使用傾向分數加權法、差異中的差異分析法以及差異中的差異中的差異分析法，探討糖尿病論質計酬計畫實施前後，對於不同城鄉，其糖尿病相關照護利用及結果之影響。
研究結果：在糖尿病論質計酬方案推行以後，在參與論質計酬方案的糖尿病患者其檢驗/檢查次數顯著增加，糖尿病相關醫療費用顯著減少，糖尿病相關門診就診次數顯著減少；居住在鄉村地區的糖尿病個案較於居住在城市地區的個案，其糖尿病相關可避免住院次數顯著降低。
結論：論質計酬方案推行後，在糖尿病照護利用面、結果面，有改善成效；居住鄉村比起居住都市有較低的糖尿病可避免住院次數。

關鍵字

糖尿病 ； 論質計酬 ； 城鄉差距

並列摘要

Background: Diabetes ranks fifth among the top 10 causes of death in Taiwan. To improve care, Taiwan introduced the “National Health Insurance Diabetes Medical Payment Improvement Program” in 2001 as an incentivized payment system to allow diabetes patients to obtain continued and complete care. Currently, Taiwan is focused on studies to improve this program, and there have been few investigations on utilization and effects of care and rural–urban differences, if any.
Purpose: To investigate the introduction of the “National Health Insurance Diabetes Medical Payment Improvement Program,” whether rural–urban differences exist among diabetes patients in this pay-for-performance program, and differences in the utilization and results of intervention with this program.
Methods: This study analyzed diabetes patients in the 2005 Longitudinal Health Insurance Database of the National Health Insurance Research Database (NHIRD). The difference-in-difference (DID) and difference-in-difference-in-difference (DDD) methods were used to investigate results before and after implementation of the pay-for-performance program, rural–urban differences in diabetes-related care utilization, and the effect of results.
Results: After implementation of the diabetes pay-for-performance program, the number of examinations among diabetes patients who participated in the program was significantly increased, diabetes-related medical costs were significantly decreased, and the number of diabetes-related medical visits was significantly decreased. Compared to urban diabetes patients, the number of avoidable diabetes-related hospitalizations among rural diabetes patients was significantly decreased.
Conclusions: After implementing of the pay-for-performance program, there were improvements in diabetes care utilization and results. Rural residents had lower avoidable hospitalization due to diabetes compared to urban residents.

並列關鍵字

Diabetes ； pay-for-performance ； rural-urban dfferences

參考文獻

13. 張順全, 賴美淑, 徐豈庸. 台灣地理區域社經差異與糖尿病患罹病, 死亡的關聯性探討. 醫護科技學刊 2005; 7:140-8.

30. 陳宗泰, 鍾國彪, 賴美淑. 另一種流行趨勢-論成效計酬的趨勢與展望. 臺灣公共衛生雜誌 2007; 26:353-70.

36. 陳明進, 黃崇謙. 全民健保支付制度改變前後公立醫院與財團法人醫院服務量及醫療利益之比較. 當代會計 2001; 2:169-94.

38. 廖慧娟. 論質計酬之健保制度. 醫療品質雜誌 2012; 6:44-9.

40. 林文德, 謝其政, 邱尚志, 吳慧俞, 黃一展. 以傾向分數配對法評估糖尿病論質計酬方案之成效. 台灣公共衛生雜誌 2010; 29:54-63.