台灣地區顏面骨骨折病患醫療資源耗用之相關因素探討

醫療費用逐年成長是所有實施健康保險國家所面臨的共同課題。本研究希望藉由健保資料庫分析台灣地區顏面骨骨折病患醫療資源耗用的情形，以了解不同病患特質，不同疾病因素，不同醫院特性和不同醫師因素間是否有差異。本研究以2001年到2010年登錄於國家衛生研究院「全民健康保險研究資料庫」之特定主題檔中，主次診斷ICD-9-CM登錄為802.0到802.9，主次手術處置ICD-9-CM之手術代碼為21.71, 21.72, 24.7, 76.70到76.79, 76.91, 76.92及93.55，符合分析之樣本數共53,147筆。使用的統計方法包括t-test、單因子變異數分析、Scheffe 事後多重比較、複迴歸分析。研究結果顯示顏面骨骨折手術住院病患，平均住院天數為8.67天，總醫療費用平均為69,599元，手術麻醉費用平均為29,269元。研究發現為性別，年齡，出院狀況，骨折類型，骨折複雜度，骨折手術類型，共病性，醫院權屬，健保轄區，醫院層級，醫師專科及醫師專科年資會影響住院天數及總醫療費用；但在預測手術麻醉費用方面，共病性被排除。本研究結果可作為健保局日後實施TW-DRG之依據，並提供各醫療機構管理者進行醫療費用成本管控之參考。

關鍵字

顏面骨骨折；醫療資源耗用

並列摘要

Growing up in health care expenses is a common issue faced by all of the countries with the implementation of national health insurance. The purpose of this study were to analyze and compare differences and effects between demographic characters of patients’ population, complexities of diseases, features of hospitals, and factors of specialists on the medical resource utilization of facial bone fractures patients in Taiwan. This is a retrospective study using the secondary data obtained from the NHIB databank. Totally 53,147 patients with facial bone fractures during 2001 to 2010, with diagnoses of ICD-9-CM codes as 802.0 to 802.9 and procedure of ICD-9-CM code as 21.71, 21.72, 24.7, 76.70 to 76.79, 76.91, 76.92 and 93.55 were selected as study population. Statistical methods were including t-test, one-way ANOVA, Scheffe Post Hoc Multiple Comparisons, and multiple regression analysis. The average hospital stay, total medical expenses and surgery & anesthesia fees of inpatient facial bone fractures patients was 8.67 days, NT$69,599 and NT$29,269, respectively. The results revealed that ages, gender and discharge status of the patients, complexity and severity of illness, types of surgery, ownership, locality, and level of the hospitals, specialism and seniority of the attending physicians had significant influences on the utilization of medical resources. The results of the study can be used by NHIB in the implementation of the TW-DRG, and the managers of the medical institutions in medical expenses cost control as a reference.