健保居家照護資源耗用者之門診、住院費用之分析

The Outpatient and Hospital Expenditure of Long-Term Home Care Patients: National Health Insurance Analysis

鍾明惠(Min-huey Chung) ； 周稚傑(Chih-Chieh Chou) ； 莊明憲(Mieng-Hsian Chuang) ； 陳永煌(Yung-hwang Chen)

《中華職業醫學雜誌》 10卷1期 (2003/01) Pp. 37-42

https://doi.org/10.30027/CJOM.200301.0006

摘要

本研究以1997年l月至12月之全民健保使用資料作分析，資料內容有住院醫療費用明細檔、門診處方及治療明細擋，分析接受居家照護使用者之健保資源耗用之情形。研究結果顯示，本研究居家照護使用者共9,027人，一年內每人居家照護平均次數為5.04次，標準差為6.1次，每次平均費用為1,764元；門診一年內平均次數為26.96次/人，標準差為24.2次，每次平均費用為1,534.1元；住院一年內平均次數為2.24次/人，標準差為2.0次，每次平均為21.83天，每次平均費用為101,153.4元。以逐步複迴歸(stepwise regression)方式分析居家照護使用者之各變項預測門診費用之R2，結果顯示門診次數可以解釋門診費用總變異量的40.03%，而人口學、疾病別等變項解釋門診費用總變異量小於1%，相對地住院天數也可以解釋住院費用總變異量的56.21%，而人口學、疾病別等變項解釋住院費用總變異量小於1%。本研究分析居家照護使用者健係資源使用情形及未來使用量之量之預估模式，以提供公共衛生決策之參考。

關鍵字

居家照護 ； 門診 ； 住院 ； 全民健保

並列摘要

The purpose of this study was to analyze the ambulatory and hospitalization expenditure in National Health Insurance (NHI) program among people receiving home care. We collected all home care beneficiaries of NHI as well as their NHI claims including the ambulatory and hospitalization costs during a period from Jan. 1 to Dec. 31, 1997. The results showed that utilization of home care services was 5.04±6.1 visits, and cost was NT$1,764 per visit for 9,027 home care patients. Utilization of ambulatory care was 26.96±24.2 visits per patient. Mean outpatient expenditure was NT$1,534 per visit. Admission utilization was 2.24±2.0. Mean expenditure was NT$101,153.4 per admission. Stepwise regression analyses found that the most important predictor of ambulatory, hospitalization expenditure was number of visits, number of admission. Such variables as demographic and number of diseases could also predict outpatient and hospital expenditure. Moreover, an assessment and prediction of home care utilization could be referred in cost control.

並列關鍵字

home care ； ambulatory ； hospitalization ； national health insurance