安寧療護使用天數對末期病人醫療資源耗用之影響

The Impact of Length of Hospice Stay on Cost

陳雪姝(Sheue-Shu Chen) ； 謝秋萍(Chy ou-Ping Hsieh) ； 李幸諭(Hsin-Yu Lee) ； 蔡瓊玉(Chiung-Yu Tsai) ； 李哲瑋(Jhe-Wei Li)

《台灣公共衛生雜誌》 34卷4期 (2015/08) Pp. 413-423

https://doi.org/10.6288/TJPH201534104039

摘要

目標：以健保資料庫探討安寧天數對末期病患醫療資源耗用的影響，期以研究結果推動安寧療護觀念以減少無效醫療。方法：此為實驗對照研究，選取2013年死亡時67歲以上接受安寧之病患，依據性別、年齡、死前366天至730天醫療點數、特定疾病等變項與非安寧者進行1:1隨機配對，兩組各有7,890人。結果：兩組皆離死亡愈近資源耗用愈高，其中安寧組死前7天內之每人醫療點數較非安寧組為低，且其差值愈接近死亡愈明顯，從65點至2,325點。而安寧使用天數與死前0~10天及0~15天之每人費用成反比，安寧天數每多一天，費用減少523及598點；再與非安寧組比較，安寧天數越多點數節省越多，惟該現象於天數達9天及17天以上才顯現。結論：安寧療護可以節省資源，但安寧天數需相當或大於每人費用觀察期間的天數，才能觀察到其資源節省的效益。另精算，安寧組7,890人相較於非安寧組於死前7天內減少約6,056萬之醫療點數。

關鍵字

安寧療護 ； 資源耗用

並列摘要

Objectives: To explore the impact of the length of hospice stay on the medical expenditure for terminally-ill patients by analysis of the database of National Health Insurance (NHI). Methods: This case-controlled study compared decedents over 67 years of age who were hospice users with non hospice decedents in 2013. After one-to-one random matching, there were 7,890 persons in each group. The variables used to create matches were age, gender, specific disease and the medical expenditure between the 366^(th) and 730^(th) days before the date of death. Results: Both hospice users and non hospice users had increased medical expenditure while approaching the date of death. In the 7 days before death, the medical expenditure per hospice users was 65 NT$ lower than that of non hospice users; the saving increased to more than 2,325 NT$ on the final day before death. The medical expenditure of within 10 days before death showed per hospice day reductions of 523 NT$. Conclusions: The longer the hospice stay, the greater the saving in medical expenditure.

並列關鍵字

hospice care ； medical expenditure

參考文獻

Greer, DS,Mor, V,Morris, JN,Sherwood, S,Kidder, D,Birnbaum, H(1986).An alternative in terminal care: results of the National Hospice Study.J Chronic Dis.39,9-26.

Campbell, DE,Lynn, J,Louis, TA,Shugarman, LR(2004).Medicare program expenditures associated with hospice use.Ann Intern Med.140,269-77.

羅紀琼()。,未出版。

Lo, JC(2002).The impact of hospices on health care expenditures- the case of Taiwan.Soc Sci Med.54,981-91.

羅健銘、陳素秋、賴允亮、林家瑾、陳建仁(2007)。住院癌末病患照護型態對住院醫療費用與住院天數之影響。台灣衛誌。26，270-82。