影響洗腎病患定期血液透析醫療資源耗用之因素

Factors Associated with Resource Utilization of End Stage Renal Dialysis Patients

鄭振廷(Chun-Ting Cheng) ； 侯宏彬(Hung-Pin Hou) ； 錢慶文(Ching-Wen Chien)

《醫務管理期刊》 6卷3期 (2005/09) Pp. 291-308

https://doi.org/10.6174/JHM2005.6(3).291

摘要

研究目的：洗腎病患醫療照護費用成長快速，已在健保總額預算產生排擠效應。所以深入分析影響洗腎醫療資源（費用）耗用之因素，並據以建構一個以病患風險校正而且更公平、更有效率的給付模式漸趨急迫。本研究主要的研究目的即在於瞭解影響洗腎病患醫療資源耗用量之影響因子，以建議未來洗腎醫療支付改革的參考依據。
研究方法：本研究以修正後的Aday and Andersen醫療利用模式為研究架構，利用DTREG軟體做分類迴歸樹分析(Classification and Regression Tree Analysis)。
資料來源：本研究以中央健康保險局北區分局轄下各醫療機構2000及2001年領有重大傷病卡且年齡18歲以上定期血液透析病患之醫療費用資料庫，連結腎臟醫學會0020年透析調查資料庫，選擇資料完整的樣本，結果共計有l,179人。
研究結果：根據CART分析結果顯示影響洗腎病患醫療耗用量的因素有人口因子中年齡及性別；疾病因子中糖尿病；透析治療困子的血清白蛋白、Kt/V、URR、nPCR及心肺比率(CTR)等；和先前醫療利用因子。而且CART分析結果對於解釋2000年和2001年洗腎總醫療費用的解釋力分別為13.60%和11.21%。
討論與建議：根據以上結果建議健保局可以利用透析等因子先將洗腎病患分類，然後再給予不同的給付以鼓勵公平且有品質的洗腎醫療照護。

關鍵字

末期腎臟病 ； 洗腎 ； 醫療資源耗用

並列摘要

Purpose: Since the implement of the National Health Insurance in 1995, expenditure used in treating End-Stage Renal Disease (ESRD) patients had influence on health care expenditure of other services. Therefore, to study factors affect health expenditures spending on ESRD patients and construct a risk adjusted formula to pay ESRD services equitably and efficiently has become more and more urgent. The main purpose of this study is to assess factors which can significantly influence health expenditure of ESRD so that it can provide a clue for future improvement in payment system of ESRD.
Method: A revised Aday and Andersen's Health Utilization Model was constructed and CART, using DTREG software, was used to analyze the model. Data: 2000 and 2001 Health spending on ESRD patients who were at least 18 and received hemo-dialysis regularly in health care institutions which located in NHIB-North Bureau region were selected and matched with Data collected by the Association of Nephrology. Only 1,179 ESRD patients were selected because of data integrity.
Results: Results of CART analysis indicate that demographic variables, e.g. gender and age, disease factors, e.g. DM., hemodialysis factors, e.g. Kt/V, albumin, URR, CTR, nPCR and previous health expenditure were factors which can influence health expenditure of ESRD patients. And these factor which could explain 13.60% and 11.21% of total variation in 2000 and 2001 health spending on hemo-dialysis.
Discussions: Base on these findings the authors suggest that the NHIB should consider dividing ESRD patients into different groups and pay their HD services according to the group an ESRD patient assigned. This payment improvement can significantly improve equity and quality of HD services.

並列關鍵字

End-stage renal disease ； Hemodialysis ； Resource Utilization

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