特殊醫療自費差額支付選擇權利探討-以血液透析過濾術為例

因應人口快速老化、多重慢性病老人的增加、以及健保財務支出大於收入等情形下；要如何努力提供兼具醫療品質與控制醫療費用，總額給付為主的方式必須改變；理想的支付制度的設計需要兼顧病人照護品質與醫療費用控制。隨著末期腎臟病患的持續增加，各家透析院所對於血液透析過濾術（HDF, hemodiafiltration）的費用更是多頭馬車，各有不同的收費標準。HDF需要自費，使得病患接受優質醫療的權利受到了損害，因為選擇治療的限制變成了經濟狀況而非病況。HDF是一個值得推行在血液透析病患的治療模式，可以有效的清除約80%的β2-微小球蛋白，甚至可以預防發生長期透析造成的類澱粉沈澱併發症。同樣2002年的（HEMO study）也指出，β2-微小球蛋白濃度對洗腎病患的罹病率和死亡率具有預測性，可提升醫療照護品質，並降低醫療成本、住院率及再住院率。在面對國內慢性透析病患數、醫療利用、與醫療費用的持續增加，以健保署過去在保險對象醫療利用資料分析的能力、以及多年執行疾病論質計酬、整合照護門診等試辦計畫的經驗，更應鼓勵腎臟科醫護專業人員適時提供衛教，使透析病患有更多元化透析選擇，以降低慢性透析病患片段式照護及門診急診住院的使用率，讓病患獲得較好的健康品質，並減緩健保署透析支付總點值的上升。希望了解HDF的優點，不管在政府的健康政策或是各級透析院所的經營中，都能對病患能產生正面助益。隨著社會群體意識的提高，相信一定能夠造福更多的透析病患，可以明顯改善副作用的不適及提昇更優質的生活品質，不僅活得長也活得好

關鍵字

血液透析；血液透析過濾；總額給付；透析產業

並列摘要

In response to the rapid population growth, the increase in the elderly with multiple chronic diseases, and the expenditures of insurance fiscal expenditures, etc.; how to strive to provide both medical quality and control medical expenses, the method of payment to the owner must be changed; the design of the ideal payment system needs to follow With the continuous increase of terminal patients, the cost of medical hemofiltration （HDF） provided by various hospitals plus a multi-head carriage, each has different charging standards. At their own expense, the right of taking patients to receive high-quality medical care is hurt, because the choice of treatment limits the economic situation rather than the condition. Small heart disease can even prevent the occurrence of complications like diabetes. In the 2002 （HEMO study）, it is also possible that a small concentration of β2-has an effect on the incidence and characteristics of dialysis nephropathy, which can improve the quality of care and reduce the cost, consumption rate and remedy medical expenses. With the continuous increase in domestic patient data, utilization, and medical expenses, it is more important to use the National Health Insurance Agency’s ability to analyze the medical utilization of insurance subjects in the past, as well as the experience of implementing disease-based remuneration and integrating nursing experience for many years. Encourage medical doctors and nursing professionals to provide health education capabilities, so that patients can choose more flexibly, reduce the utilization rate of mental health care painful shots and outpatient emergency health care, so that the affected area can obtain better health quality, and reduce health care operations Pay for the increase in the total price. With the improvement of social group awareness, I believe it will be able to benefit more pain, and can significantly improve worsening problems and better quality. Quality of life, long and good life