美國癌症登記及老人醫療保險資料庫之發展與應用－論台灣癌症登記與健康保險聯結資料庫之可行性

Development of the TCDB-NHIRD Linked Database: What Can We Learn From The SEER-Medicare Database In The United States?

潘憶文(I-Wen Pan) ； 簡君儒(Chun-Ru Chien) ； 施雅真(Ya-Chen Tina Shih)

《台灣公共衛生雜誌》 31卷4期 (2012/08) Pp. 299-310

https://doi.org/10.6288/TJPH2012-31-04-01

摘要

根據美國國家癌症研究中心的統計，到2011年1月止，運用美國癌症登記（Surveillance, Epidemiology, and End Results Program，簡稱SEER）及老人醫療保險（簡稱Medicare）行政申報資料庫連結資料庫發表在同儕審查期刊的文章已超過650篇以上，在癌症醫療品質及成本相關的研究有卓著的成果。我國全民健康保險自1995年開始辦理，全民健康保險資料庫業已廣泛應用，另一方面我國癌症登記資料庫也漸趨成熟。若能將兩者結合，應可發揮相當程度的綜效。本文的目的是希望藉由他山之石，提供我國未來整合癌症相關資料庫供臨床、學術研究應用及政策評估之參考。本篇文章將針對以下內容作介紹：資料蒐集之行政層級及架構、資料庫的結構、附加應用軟體及程式介紹、資料庫驗證（Validation）與申請費用、資料庫的使用限制與病人個別資料保護，並以乳癌為例，說明該資料庫在臨床研究、醫療品質及癌症治療成本研究方面之應用，並提供建議。

關鍵字

癌症登記 ； 醫療保險 ； 行政申報資料庫

並列摘要

In the United States, the SEER-Medicare data link cancer patients in the SEER (Surveillance, Epidemiology, and End Results) Program with Medicare enrollment to identify cancer patients who are eligible for Medicare and to provide Medicare Claims for these patients. Statistics from the National Cancer Institute show that there are over 650 peer-reviewed publications using the SEER -Medicare database. This database has been the primary data source for health services research in oncology since its inception, and it has made tremendous contributions to policies related to cancer control, treatment, and surveillance in the United States. The National Health Insurance Research Database (NHIRD), established at the initiation of the Taiwan's National Health Insurance program in 1995, is a claims database. The Taiwan Cancer Database (TCDB), based on the Taiwan Cancer Registry, was established in 2002. The creation of a TCDB-NHIRD linked database could produce a SEER-Medicare-like database and has the potential to become an invaluable resource for cancer as well as policy researchers in Taiwan. This paper introduces the SEER-Medicare database, including data collection, software, applications of the database, data elements, structure, validation, the data request and application process, limitations of the database, and privacy and confidentiality issues. We then use a previously published breast cancer study to demonstrate the procedures involved in generating research from the SEER-Medicare database, followed by recommendations for the future development of a database that links TCDB to the NHIRD.

並列關鍵字

Cancer Registry ； Medicare ； Claim database

參考文獻

Health Services and Economics, National Cancer Institute. SEER-Medicare: medicare claims files. Available at: http://healthservices.cancer.gov/seermedicare/medicare/claims.html. Accessed August 25, 2011.

Health Services and Economics, National Cancer Institute. Number of part D enrollees. Available at: http://healthservices.cancer.gov/seermedicare/aboutdata/enrollees.html. Accessed August 25, 2011.

Health Services and Economics, National Cancer Institute. SEER-Medicare: number of cases table. Available at: http://healthservices.cancer.gov/seermedicare/aboutdata/numcases.html. Accessed November 18, 2011.

Health Services and Economics, National Cancer Institute. Procedure codes for SEER-Medicare analyses. Available at: http://healthservices.cancer.gov/seermedicare/considerations/procedure_codes.html. Accessed November 18, 2011.

Health Services and Economics, National Cancer Institute. SEER-Medicare: defining the date of diagnosis & treatment. Available at: http://healthservices.cancer.gov/seermedicare/considerations/date.html. Accessed November 18, 2011.