臺灣地區癌症病患使用醫療費用及其財務保障之探討

Hospitalization Costs and Financial Protection of Cancer Patients in Taiwan

劉威辰(Wei-Chen LIU)

指導教授 ： 鄭文輝

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

中文摘要
本研究旨在探討癌症病患可能使用的全民健保的醫療費用及其面臨的財務風險問題，主要探討的內容有下列三項：
一、根據相關文獻及實證探討，常見五大癌症(肝癌、肺癌、結腸直腸癌、胃癌、口腔癌)的治療過程及其罹病成本。
二、五大癌症病患不同年齡層及臨終前五年不同存活年數的癌症醫療費用支出型態。
三、探討全民健保未給付項目所造成的財務負擔，並分析商業健康保險保單對於癌症病患提供的補充性保障。

本研究方法概念係先對五大癌症之病情發展及檢查治療作一瞭解，繼則使用國家衛生研究院「全民健康保險資料庫」2000年至2004年二十萬人承保抽樣歸人檔之「住院醫療費用清單明細檔」進行統計分析篩選五大癌症患者在此存活五年期間內死亡人口，共912人次的醫療費用。再以案例實際瞭解商業健康保險對癌症病患提供的保障內容。最後根據。
本研究主要發現如下：
一、五大癌症病患臨終前醫療費用與存活年數呈現正相關成長；癌症多數趨勢顯示，45至64歲組群的醫療費用高於65歲以上族群。
二、自付費用佔醫院向全民健保申請費用二成，高則一百萬元，顯然一般民眾仍然無法負擔得起。
三、現行商業健康保險中，癌症保險保單僅團體險提供實支實付之給付型態。
四、商業健康保險之癌症保單，以實支實付之給付型態相較於定額給付型對被保險人有利。
綜合上述本研究可做幾項建議如下：
一、對民眾之建議
(一) 癌症末期病患平均仍需自付二十萬左右，最高必須自付一百萬元，作為民眾購買商業健康保險之參考。
(二) 建議民眾購買商業健康保險以降低健康財務風險。如可選擇給付型態，並建議選擇以實支實付的給付型態，以增加其保障涵蓋範圍。

二、對商業健康保險的建議
(一) 基於保險公司對於社會責任上，以公司能力下承擔風險，建議開發實支實付之給付型態，更可表彰商業保險的社會意義。增加精算各給付項目的使用次數以及所需費用，分層列出清單，允許投保人於要保時事先選擇使用，甚至事後選擇。
(二) 提供被保險人以保單價值範圍內的無息借款，以先行支付醫療費用，待事後申請保險給付時，再行償還，以避免被保險人另尋資金支應醫療費用之負擔。

三、對全民健康保險之建議
(一) 建議全民健保適度增加癌症治療給付的項目。
(二) 以民眾健康為考量，標準化癌症治療，進一步提供合理化配套支付標準。

四、對衛生署之建議
衛生署之健康促進政策應加強對45-64歲之中壯年人口的健康加以關心，早期發現，早期篩檢，該族群若罹患癌症，以減少高昂的醫療費用。

關鍵字

全民健康保險 ； 商業健康保險 ； 自付額 ； 癌症治療

並列摘要

Abstract
This study aims to examine the cancer patients’ hospitalization costs and their financial risk problems. The following three issues will be investigated:
First, according to relevant documents and empirical data, the treatment courses and the accompanying costs of five major cancers (liver cancer, lung cancer, colon and carcinoma of the rectum, stomach cancer, oral cavity cancer) will be explored.
Second, expenditure patterns of treating five major cancers by patient's ages and surviving five years approaching end of life will be analyzed by using a sample of 912 patients.
Third, the financial burden of out-of-pocket expenditure under national health insurance and the supplementary coverage of private health insurance will be look into.

Four major finding of this study are as the following:
First, the hospitalization costs of five major cancers are positively correlated with surviving years and the treatment expenditures for patients aged 45 to 64 years are higher than those of other age group.
Second, the out-of-pocket expenditure account for about 20% of national health insurance payments that may cost up to one million NT dollars, a great financial burden to most of families.
Third, under current private health insurance practice, only a few group insurance policies offers itemized indemnity payment.
Fourth, itemized indemnity payment provides better financial protection to cancer patients than per diem payment.

Four aspects of suggestions can be derived from this study:
First, suggestions to the public:
1. Since the average out-of-pocket expenditure for cancer treatment is about 200,000 NT dollars, and may be up to one million NT dollars, buying private health insurance policy to cover these expenses should be encouraged.
2. Since itemized indemnity policy provides better protector than per diem payment for cancer patients, it should be a better policy choice for the insured.

Second, suggestions to the private health insurance
1. To meet the need of cancer patients, itemized indemnity policies should be developed.
2. To relieve the burden of financing out-of-pocket expenditure of cancer patients, pre-payment free of interest should be allowed.

Third, suggestions to national health insurance:
1. Payment coverage for treating cancers under current national health insurance should be relieved and adjusted.
2. Procedure of cancer treatment should be standardized and reasonable payment should be offered.

Fourth, suggestions to National Health Administration:
Since treatment costs of cancer patients aged are quite high, cancer for the heath status of the group and taking necessary preventive measures should be the focus of current health promotion policy.

並列關鍵字

National Health Insurance ； Private Health Insurance ； Payment System ； Cancer Treatment

參考文獻

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