臺灣全民健康保險制度下髖關節置換手術之醫療利用與費用

Medical Utilization and Expenditure of Hip Replacement under the National Health Insurance Program in Taiwan

林亞蓉(Ya-Jung Lin) ； 楊榮森(Rong-Sen Yang) ； 曹昭懿(Jau-Yih Tsauo)

《物理治療》 32卷4期 (2007/08) Pp. 200-209

摘要

Purpose: The objective of this study was to compare the incidence rate, cost and subject characteristics of total hip replacement (THR), partial hip replacement (PHR), and revision of hip replacement (RHR) between annual year 1997 (from July 1, 1997 to June 30, 1998) and annual year 2002 (from July 1, 2002 to June 30, 2003) under the National Health Insurance (NHI) program in Taiwan. Method: The registry for contracted medical facilities (HOSB files) and the inpatient expenditures by admissions data files (DD files) in annual year 1997 and 2002 offered by National Health Research Institutes were analyzed in this study. The research variables included operation type, age, gender, causes of operation, external causes if provided, the accreditation level of executing hospitals and cost. Results: The incidence of hip replacement significantly increased by 22.6% between 2 annual years (p＜0.001; 10961 cases and 13441 cases in annual year 1997 and 2002, respectively). The total medical costs increased by 22.0% between 2 annual years (1.28 billion and 1.56 billion in annual year 1997 and 2002, respectively). The average operation age of THR and PHR significantly increased by 3 to 4 years (p＜0.001), but that of RHR didn't. The incidence rate and cost of PHR were highest among hip replacements. Among subjects undergone PHR, elderly (especially at the 70-79 age group) and female were most common. The main causes of PHR were fracture of neck of femur (ICD9CM_CODE: 820; 69.5% and 76.0% in annual year 1997 and 2002, respectively) and fall (Ecoed: E885 and E888; 61.6% and 68.7% in annual year 1997 and 2002, respectively). Among subjects undergone of THR and RHR, the 60-69 age group was most common. In contrast with PHR, more males underwent THR and RHR than females. The major causes of THR were mainly other disorders of bone and cartilage (ICD9CM_CODE: 733; 47.9% and 46.0% in annual year 1997 and 2002, respectively) and osteoarthrosis and allied disorders (ICD9CM_CODE: 715; 38.2% and 42.8% in annual year 1997 and 2002, respectively). The major cause of RHR was complications peculiar to certain specified procedures (ICD9CM_CODE: 996; 77.2% and 83.8% in annual year 1997 and 2002, respectively). Conclusion: The incidence and total cost of hip replacements increased substantially between annual year 1997 and annual year 2002. The increment seemed more significantly in female, elderly and people with fall as an external cause. We should focus prevention of age-related osteoporosis, fall problem in elderly to decrease the medical burden.

關鍵字

全髖關節置換手術 ； 半髖關節置換手術 ； 髖關節再置換手術 ； 全民健康保險 ； 醫療費用

並列摘要

Purpose: The objective of this study was to compare the incidence rate, cost and subject characteristics of total hip replacement (THR), partial hip replacement (PHR), and revision of hip replacement (RHR) between annual year 1997 (from July 1, 1997 to June 30, 1998) and annual year 2002 (from July 1, 2002 to June 30, 2003) under the National Health Insurance (NHI) program in Taiwan. Method: The registry for contracted medical facilities (HOSB files) and the inpatient expenditures by admissions data files (DD files) in annual year 1997 and 2002 offered by National Health Research Institutes were analyzed in this study. The research variables included operation type, age, gender, causes of operation, external causes if provided, the accreditation level of executing hospitals and cost. Results: The incidence of hip replacement significantly increased by 22.6% between 2 annual years (p＜0.001; 10961 cases and 13441 cases in annual year 1997 and 2002, respectively). The total medical costs increased by 22.0% between 2 annual years (1.28 billion and 1.56 billion in annual year 1997 and 2002, respectively). The average operation age of THR and PHR significantly increased by 3 to 4 years (p＜0.001), but that of RHR didn't. The incidence rate and cost of PHR were highest among hip replacements. Among subjects undergone PHR, elderly (especially at the 70-79 age group) and female were most common. The main causes of PHR were fracture of neck of femur (ICD9CM_CODE: 820; 69.5% and 76.0% in annual year 1997 and 2002, respectively) and fall (Ecoed: E885 and E888; 61.6% and 68.7% in annual year 1997 and 2002, respectively). Among subjects undergone of THR and RHR, the 60-69 age group was most common. In contrast with PHR, more males underwent THR and RHR than females. The major causes of THR were mainly other disorders of bone and cartilage (ICD9CM_CODE: 733; 47.9% and 46.0% in annual year 1997 and 2002, respectively) and osteoarthrosis and allied disorders (ICD9CM_CODE: 715; 38.2% and 42.8% in annual year 1997 and 2002, respectively). The major cause of RHR was complications peculiar to certain specified procedures (ICD9CM_CODE: 996; 77.2% and 83.8% in annual year 1997 and 2002, respectively). Conclusion: The incidence and total cost of hip replacements increased substantially between annual year 1997 and annual year 2002. The increment seemed more significantly in female, elderly and people with fall as an external cause. We should focus prevention of age-related osteoporosis, fall problem in elderly to decrease the medical burden.

並列關鍵字

Total hip replacement ； Joint revision ； Joint arthroplasty ； Medical cost ； Health insurance