以SARS經驗推估禽流感爆發對醫療利用可能影響之初探

A Preliminary Analysis of the Possible Influence of H5N1 Influenza Outbreak on Medical utilization-experience from SARS Outbreaks

張琇珺(Hsiu-Chun Chang) ； 林恆慶(Herng-Ching Lin) ； 陳靖宜(Chin-Yi Chen) ； 陳楚杰(Chu-Chieh Chen)

《台灣公共衛生雜誌》 27卷6期 (2008/12) Pp. 496-506

https://doi.org/10.6288/TJPH2008-27-06-04

摘要

目標：以嚴重急性呼吸道症候群(SARS)相關病患的醫療利用資料，推估禽流感人傳人疫情爆發時，不同侵襲率下的住院醫療利用及其相關因素。方法：運用國家衛生研究院發行之全民健康保險資料庫，選取與禽流感傳染毒力相似的366位SARS相關住院病患為研究對象。統計方法包括卡方檢定、獨立t檢定、變異數分析、複迴歸分析。結果：以同時考量是否院內死亡與病患年齡時所推估的住院費用總額為11.69億元至27.27億元最高，且以65歲（含）以上的老年人病患的總住院費用最高；其次，獨立影響住院費用的顯著相關因素有病患性別、是否院內死亡、醫院層級別、醫院權屬別及住院天數，且以區域醫院的住院費用最低；最後，獨立影響住院天數的顯著相關因素為就醫醫院層級別。結論：建議衛生主管機關事先制定相關衛生政策及規劃禽流感專責醫院時應以區域級醫院為優先考量，以降低老年人罹病之風險及減少醫療費用的支出。

關鍵字

禽流感 ； 醫療利用 ； 嚴重急性呼吸道症候群

並列摘要

Objectives: This study calculated the hospital admission expenditures required for responding to different attack rates of pandemic H5N1 influenza, and explored the factors related to medical utilization that were required during Severe Acute Respiratory Syndrome (SARS) outbreaks. Methods: Records retrieved from the National Health Insurance (NHI) database developed by the National Health Research Institution (NHRI) showed that there were 366 inpatients with SARS in 2003. The data were analyzed using inferential statistical techniques, including the independent t-test, χ2-test, ANOVA and linear regression. Results: The findings revealed that for attack rates of 15%, 25% and 35%, the estimated admission expenditures were the highest when considering in-hospital death and patient age simultaneously. Total admission expenditures for elderly patients over the age of 65 years were higher than those for other age groups. Secondly, factors that were determined to be related to admission expenditures were patient gender, in-hospital death, hospital level, hospital ownership and length of stay (LOS). Finally, the related factors of LOS were at the hospital level. Conclusions: Total admission expenditures for elderly patients over the age of 65 years were higher than those for other age groups. Hence, we suggest a specific health policy for this group to reduce the risk of disease and medical expenses. Secondly, because admission expenditures were highest in local hospitals and lowest in regional hospitals, we suggest that regional hospitals be given priority if health authorities designate exclusive hospitals for treating H5N1 influenza.

並列關鍵字

H5N1 influenza ； medical utilization ； Severe Acute Respiratory Syndrome

參考文獻

張樂心、鄭守夏、楊銘欽、江東亮(2004)。醫院權屬別與醫療收費。台灣衛誌。23，130-140。

Aday LA,Andersen RM(1974).A framework for the study of access to medical care.Health Serv Res.9,208-220.

Charlson ME,Pompei P,Ales KL,Mackenzie CR(1987).A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis.40,373-383.

Deyo RA,Cherkin DC,Ciol MA(1992).Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol.45,613-619.

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO