台灣地區黃斑部病變病患的醫療資源耗用

背景:黃斑部病變目前是全世界高齡化人口眼睛失明的主要原因，但其有效治療在最近數年才開始進行。事實上，台灣社會人口的老化，黃斑部病變盛行率開始升高，但是國人普遍對這種會失明的疾病並沒有預防及治療的概念。將來老年人黃斑部病變治療與防治將會是我國視力保健醫療上未來的重點。黃斑部病變不但直接影響病患的生活品質，且會衍生極其龐大的醫療費用，因此有效協助病患醫療已成為醫院和醫療界不可忽視的重大任務。目的: 台灣有關黃斑部病變盛行率增加，進而提升醫療資源耗用，相關成本效益及醫療費用分析較少，本研究主要探討台灣地區黃斑部病變之醫療費用耗用分析及醫療成效，期望研究結果能提供國內醫療團隊參考。研究方法: 根據眼科臨床專家建議50歲以上病患為黃斑部病變之主要好發族群，本研究透過國家衛生研究全民健康保險學術資料庫，2010年版百萬歸人檔資料，選取2004~2008年ICD-9-CM為362.4和362.5診斷碼的黃斑部病變病患，同時篩選條件年齡大於50歲者為統計之樣本。依照ICD-9-CM診斷碼黃斑部病變可區分為乾性和濕性兩類，本研究追蹤每個病患五年之醫療耗用情況，採用SAS Institute Inc.開發之統計軟體SAS 9.4版，進行描述性及推論性之統計分析，描述性之統計結果以平均數及標準差、樣本數與百分比之方式呈現，推論性統計則透過t檢定和變異數分析，探討黃斑部病變患者在人口學及疾病特性與其總醫療費用之關係：以卡方、線性複迴歸分析，探討其依變項與門、急、住診醫療耗用之顯著差異。最後再以複迴歸分析控制其他變項下(如性別、年齡等)，探討醫療耗用之變化。結果: 本研究針對黃斑部病變進行五年醫療資源耗用之統計分析與探討，發現無論哪一種醫療費用皆有顯著性差異。隨著黃斑部病變越來越嚴重，黃斑部病變在醫療耗用也逐漸加重，不但使得病患的生活品質下降，更使健保財務窘境日益加重。透過本研究結果，期望醫療機構可提升病患醫療品質與降低醫療費用。

關鍵字

黃斑部病變、醫療耗用、健保資料庫

並列摘要

BACKGROUND： Age Macular Degeneration (AMD)is the main cause of loss vision and eventually blindness which is prevalent in old age population in the world. Effective treatment for disease was bounded in recent years. As a matter of fact, when the general population get older in Taiwan,the occurance of AMD is more prevalent. Since the importance of prevention become more prominent effort for ophthalmology society in order to preserve patient’s vision, their quality of life also control rising medical expense for treating this disease. So prevention,education ,helping patient with AMD become the major task for medical society. Objective：This research paper collect data from years record of treating AMD in Taiwan ,such as their medical expense & result of treatment. As to provide a reference to local medical society for treating AMD in a more cost effective way. Methods： According to ophthalmology suggestion that patient over 50 years old are the group of patient offen suffer from AMD.This research collect data from National Health Insurance data base from the year 2004∼2008 with Diagnostic Code ICD-9-CM 362.4 and 362.5 for AMD. Selecting patient with age over 50 years old & with ICD 9 MD. Code. I trail every patient medical expense in 5 years by using SAS Institute Inc. software version SAS 9.4 for descriptive and inferential statistical analysis Results: The medical expense increase at the same time ,the AMD disease become more severe & patient’s quality of life declines .So by this reaserch ,the medical population should treat AMD patient in its early stage for preserving his vision & improving his quality of life & reducing medical expense.