台灣癌症病患的健保安寧療護利用情形與費用分析

Utilization of and Expenditures for Palliative Care for Cancer Patients under the National Health Insurance in Taiwan

劉嘉年(Chia-Nien Liu) ； 楊銘欽(Ming-Chin Yang)

《台灣公共衛生雜誌》 26卷2期 (2007/04) Pp. 118-127

https://doi.org/10.6288/TJPH2007-26-02-04

摘要

目標：分析台灣癌末病患對健保安寧療護的利用度、費用以及使用者特性。方法：以2001-2004年全民健康保險資料庫之門、住診資料，篩選符合癌症診斷且曾經接受過健保安寧療護服務者為研究對象，分析其整體住院安寧病房與居家安寧門診的人次與費用，及其在病患性別與年齡別的差異。結果：台灣癌症病患每年使用居家、住院安寧療護或兩者皆使用的人數，自2001年的4,633人逐年增加為2004年的6,426人，佔各年因癌症死亡人數的14.0%-17.7%之間，健保給付安寧療護服務的總費用，自2001年的2.14億逐年增加到2004年的2.83億，並以支付住院安寧療護為主佔89.2%-94.0%。使用安寧療護服務最多的前五項癌症診斷為肺癌、結腸直腸癌、肝癌、口腔癌、胃癌。醫學中心與區域醫院是癌症病患主要的求醫場所，合計的門診與住院人次分佔總人次的70.5%與92.3%，80%的安寧療護費用支付給6縣市的醫療機構。結論：台灣癌症病人使用安寧療護之比率較國外為低且集中於醫學中心，宜增強安寧療護的資源分布並向病患及家屬宣導，以提昇癌末病患照護品質。

關鍵字

癌症 ； 全民健保 ； 安寧療護 ； 醫療利用度 ； 醫療費用

並列摘要

Objectives: To explore the utilization of and health care expenditures for palliative care and characteristics of palliative care-seeking for cancer patients in Taiwan. Methods: As our sample, we selected cancer patients who had used palliative care from the outpatient and hospital claims data of the Bureau of National Health Insurance (BNHI) between 2001 and 2004. We explored total palliative care use and expenses, age and gender, and differences in in-patient hospice care and outpatient visits of hospice home care. Results: A total of 4,633 persons used hospice or hospice home care in 2001; this increased to a total of 6,426 persons in 2004, representing 14.0%~17.1% of the total number of cancer patients treated between 2001 and 2004 in Taiwan. Total expenditures for palliative care for cancer patients increased from NT$214 million in 2001 to NT$283 million in 2004. Hospice care accounted for 89.2%-94.0% of all palliative care expenses. The five leading cancer diagnoses of palliative care patients were lung, colorectal, liver, oral, and gastric cancer. Medical centers and regional hospitals were major places of palliative care-seeking for cancer patients, accounting for 70.5% of hospice home care visits and 92.3% of hospice admissions. Among all healthcare institutions receiving payment for palliative care expenses, 80% were located within 6 cities or counties. Conclusions: Utilization of palliative care for cancer patients in Taiwan was lower than in other countries and was concentrated in medical centers. In order to improve end-of-life care for cancer patients, we suggest that NHI should encourage hospitals to provide more palliative care resources and educate the general public about the benefits of palliative care.

並列關鍵字

Cancer ； National health insurance ； Palliative care ； Health care utilization ； Health care expenditure

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