- 期刊
The Utilization of Nuclear Medicine Studies and the Dilemma in Taiwan: A Brief Report
台灣核醫診療健保使用長期趨勢分析及困境
摘要
The nuclear medicine (NM) studies have been reimbursed by Taiwan's National Health Insurance since its start in 1995. In the past two decades, the utilization of NM studies had expanded. According to the preliminary analysis based on the Taiwan's National Health Insurance Research Database (NHIRD) span from 2000 to 2012, the increment is most significant in stress and redistribution myocardial perfusion scan (250 studies/year/million people), followed by wholebody bone scan (176 studies/year/million people), and wholebody PET scan (100 studies/year/million people). Due to the limited access of radiopharmaceuticals, especially the Tc-99m generator, the costs of NM scans were much higher while the payment rates were nearly unchanged. The cost of radiopharmaceuticals attributed to 33%～109% of the total NHI payment rate for each NM scan. Summed up with the direct costs including instrument, technologists, and doctors, the cost-to-payment ratios of all NM studies range from 60% to 143% (average 90%), not mentioned the other indirect costs including nursing, administration, hardware and software for computer, maintenance fee, electricity, radiation safety program, etc. In approximately one third of the NM scans, the direct costs would exceed the total NHI payment. The inappropriate payment rates limit the quality improvement of NM studies, such as shift to better radiopharmaceuticals, upgrade the equipment system and software, etc. To ensure the progress of NM studies, which can help clinical management, especially for cardiovascular and oncologic diseases, the Society of Nuclear Medicine, Taiwan should take the responsibility to propose new payment rates to the NHI.
並列摘要
台灣全民健保自1995年開辦以來，各種核子醫學檢查已納入保險給付範圍，過去20年間，核醫檢查的應用日漸增加。初步分析全民健保資料庫，2000至2012年間，核醫檢查量平均年增率最高前三項檢查依序為Stress & redistribution myocardial perfusion study（增加250次／年／百萬人）、Whole body bones can（增加176次/年/百萬人）、Whole body PET（增加100次／年／百萬人）。由於核醫放射性藥物，尤其是鎝99m孳生器，的取得日益困難，核醫檢查的成本隨之大幅上漲，但健保的核醫檢查給付自開辦以來卻幾乎從未調整。核醫檢查使用的放射性製劑的成本占健保給付檢查價的33%～109%，若再加上儀器、放射師及醫師人力等直接成本，一個核醫檢查的總直接成本平均為90%(33～143%)的健保支付價格，而這並不包含其他間接成本如護理人力、行政人力、儀器保養維修、空間及電力、電腦軟硬體設備、輻射安全作業……等等的間接成本。更有將近三分之一的核醫檢查，光是檢查直接成本就已經超過健保給付的價格。不合理的給付價格限制了提升核醫檢查品質的機會，造成無法使用或引進更好的放射性製劑，醫療機構無法更新造影儀器設備或升級電腦系統及軟體……等等。為能提升國內核醫檢查檢查品質，確保國人的健康照護成果，尤其是心血管疾病及癌症兩項重大疾病，中華民國核醫學會應責無旁貸，向中央健保署提出更合理的核醫檢查給付方案。