全民健康保險重大傷病患者住院醫療資源使用

Inpatient Care Use by Patients with Catastrophic Illness under National Health Insurance in Taiwan

盧瑞芬(Jui-Fen Rachel Lu) ； 李佳琳(Chia-Lin Li) ； 莊逸洲(Yi-Chou Chuang)

《中華公共衛生雜誌》 18卷4期 (1999/08) Pp. 283-292

https://doi.org/10.6288/CJPH1999-18-04-07

摘要

目標：分析全民健保所定義重大傷病患者的住院醫療資源使用情形，及初步評估全民健保對重大傷病族群的影響。方法：本研究主要分析比較全國各類重大傷病患者在1996年全年的住院醫療費用分佈情形，同時以林口長庚醫學中心為例，比較各類重大傷病患者在健保前後的住院醫療資源使用情形。結果：本研究有三點主要發現：⑴全國性全民健保重大傷病資料顯示，第1類癌症的人數最多，而住院費用分佈有偏右趨勢（平均值大於中位數）。⑵以林口長庚醫學中心為例，健保後的各類重大傷病患者，其平均住院日數及平均住院費用大都較健保前高，平均年齡則較低。⑶部分重大傷病持卡人的入院診斷，完全不符合中央健保局現定的重大傷病範圍。結論：重大傷病的認定標準，宜採用ICD-9-CM編碼；且重大傷病應持續多年期研究。

關鍵字

部份負擔 ； 重大傷病 ； 醫療資源使用 ； 全民健保

並列摘要

Objectives: This study is designed to evaluate inpatient care utilization patterns of patients with catastrophic illness as defined by the Bureau of National Health Insurance (BNHI), Taiwan. In addition, the impact of National Health Insurance (NHI) on inpatient care utilization for this specific group is assessed. Methods: The distribution of inpatient health expenditures is analyzed using the BNHI national database for 1996. In addition, comparisons in inpatient uses between pre-NHI and post-NHI periods are male using data from Linkou Chang Gung Memorial Hospital (CGMH). Results: Our study has three major findings: (1) The NHI national databases on catastrophic illness demonstrate that the first category, malignant neoplasm, has the largest number of patients. The distribution of inpatient medical expenditure is skewed to the right (mean value is greater than the median). (2) As evidenced by the Linkou CGMH database, most of the catastrophically ill patients have demonstrated higher average annual hospital days and hospital expenses, but lower average age in the post-NHI period than in the pre-NHI period. (3) Some catastrophic illness certificate holders have indicated no NHI-defined catastrophic illness related to admitting diagnoses. Conclusions: Catastrophic illness certificates should be granted based on ICD-9-CM codes. Moreover, research on catastrophic illness should be performed on a long-term basis.

並列關鍵字

copayment ； catastrophic illness ； health care utilization pattern ； National Health Insurance