台灣成年民眾於死亡前三個月健保醫療費用支出之影響因素分析

Factors Affecting the Expenditure of NHI by Adult Beneficiaries in Their Last Three Months of Life in Taiwan

劉嘉年(Chia-Nien Liu) ； 楊銘欽(Ming-Ching Yang) ； 楊志良(Chih-Liang Yaung)

《台灣公共衛生雜誌》 20卷6期 (2001/12) Pp. 451-462

https://doi.org/10.6288/TJPH2001-20-06-05

摘要

目標：臨終成本是衛生服務研究的重要課題之一，本研究的目的在探討影響台灣成年民眾於死亡前三個月健保醫療費用支出的因素。方法：採次級資料分析法，由衛生署死因資料檔中，以簡單隨機抽樣的方式，選取一萬名於1999年死亡的20歲以上台灣民眾，以身分證字號連結門診、住院明細檔與醫令檔。經歸戶後共有8.124人為臨終組樣本。並參照Andersen 醫療服務利用的行為模式，從前傾、需要與能力資源三個因素，再加上加護醫療利用因素，共同探究死亡前三個月醫療費用的影響因素。結果：死亡前三個月的醫療費用受到需要、前傾、能力資源、與加護醫療利用因素的影響，整體模型的解釋力高達75.20%：結論：本研究確認出影響臨終醫療費用的重要特質，並建議未來研究應關切臨終照護服務的適切性，並進一步探究年齡、婚姻狀態、地區醫療資源與臨終醫療費用的關係。

關鍵字

臨終成本 ； 醫療費用 ； 全民健康保險

並列摘要

Objectives: The costs of health care at the end of life are a major issue of health services research. The purpose of this study is to examine the factors related to expenditure of NHI in the last three months of life by adult people who died in 1999 in Taiwan. Methods: Ten thousand individuals aged 20 and over who died in 1999 were randomly selected from the Death Certificate data file. To obtain a complete record of the National Health Insurance reimbursement and utilization experience for these deceased individuals, we linked the sample to the inpatient claims and the outpatient claims files provided by the Bureau of the National Health Insurance. Of this sample, 8,124 of the deceased were matched. The logged sum of an individual's last three months expenses was modeled using intensive care utilization variables and variables specified in the behavioral model of health services utilization developed by Andersen. The behavioral model views the use of health services as a function of the predisposing, enabling, and need characteristics of an individual. Multiple regressions were employed for data analysis. Results: The health care expenditure of the last three months was related to predisposing, need, enabling characteristics, and intensive care utilization variables. The multivariable regression model explained 75.20% of teristics related to the expenditure of NHI by adult beneficiaries in their last three months of life in Taiwan. We suggest that the appropriateness of care for terminal patients, and the relationship between dying cost and age, marital status, regional health care resource deserve further study.

並列關鍵字

Cost of dying ； Health care expenditure ； National health insurance.