Impact of National Health Insurance on the Survival Rate of Patients with Osteosarcoma in Taiwan: Review of 74 Patients

台灣全民健康保險對骨肉瘤病人存活率之影響－74位病人之回顧

方璟文(Kein-Boon Poon) ； 簡松雄(Song-Hsiung Chien) ； 林高田(Gau-Tyan Lin) ； 王國照(Gwo-Jaw Wang)

《The Kaohsiung Journal of Medical Sciences》 20卷5期 (2004/05) Pp. 230-234

摘要

自1990年5月至2001年5月，我們共治療了74位高度惡性骨肉瘤的病人。年齡分佈為7歲至63歲，中數為17歲。台灣1995年3月日實施全民健康保險，在全民健康保險實施之前，兩年存活率為46.9%，實施之後增加為73.8%。5年存活率也從37.5%增加至63.6%。在我們的研究裡，不足夠的手術切割邊、對化療反應差、疾病較末期及治療不完整的病人，其預後都比較差。在全民健康保險實施之前，有10位病人無法接受完整的治療，主要是無法負擔醫療費用。全民健康保險實施之後，只有3位病人因為個人因素而無法接受完整的治療。化學治療的進步大大的提高了病人的存活率，而全民健康保險的實施讓病人可以無後顧之憂的完成昂貴的療程，包括術前化療、保肢手術及術後化療。全民健康保險提高了病人的就醫率而使早期骨肉瘤病人的數目增加，因而改善了骨肉瘤病人之存活率及提高了接受保肢手術的病人數。我們的結論是全民健康保險的實施明顯的改善了台灣骨肉瘤病人之存活率。

關鍵字

全民健康保險 ； 骨肉瘤 ； 存活率 ； 台灣

並列摘要

The 2-year survival rate for high-grade osteosarcoma was 46.9% before the introduction of National Health Insurance (NHI) in Taiwan on March 1, 1995, but increased to 73.8% after the implementation of NHI. The 5-year survival rate also increased, from 37.5% to 63.6%. Between May 1990 and May 2001, 74 patients with high-grade osteosarcoma were treated at our hospital. Median age was 17 years (range, 7-63 years). Inadequate surgical margins, poor histologic response to chemotherapy, advanced stage of disease, and incomplete treatment were strongly associated with poor prognosis. Before NHI, 10 patients had incomplete treatment, mainly because of unaffordable medical fees. After NHI, only three patients had incomplete treatment, due to personal reasons. Patient survival improved dramatically with advances in multiagent chemotherapy, but it was the NHI that enabled patients to complete expensive treatment courses, including preoperative neoadjuvant chemotherapy, limb-salvage surgery, and postoperative adjuvant chemotherapy. The NHI also improved the accessibility of medical care, with more patients presenting in the early stages of disease and, as a result, it not only improved survival rate but also increased the number of patients undergoing limb-salvage surgery. We concluded that the NHI significantly improved the survival rate for patients with osteosarcoma in Taiwan.

並列關鍵字

National Health Insurance ； osteosarcoma ； survival rate ； Taiwan