醫療院所特質與醫師特質對未成年氣喘患者資源耗用的影響

The Impact of the Characteristics of Medical Care Organizations and Physicians on Medical Resource Utilization by Children with Asthma

黃家達(Jia-Da Huang) ； 周雨青(Yu-Ching Chou) ； 楊哲銘(Che-Ming Yang) ； 黃國哲(Kuo-Cherh Huang)

《醫務管理期刊》 13卷4期 (2012/12) Pp. 249-260

摘要

目的：氣喘是一種呼吸道慢性發炎的疾病，病患通常需要長期性的藥物治療以避免病情更進一步的惡化。兒童的呼吸道較成人窄小，造成氣喘的發生對兒童更為嚴重，因而導致耗用更多的醫療資源。因此，就有效使用醫療資源此議題而言，未成年氣喘患者是重要的研究對象。本研究的目的旨在探討醫療院所及醫師特質對未成年氣喘患者的醫療資源耗用之影響。方法：本研究的資料來源為2010年全民健保資料庫，選取兒童氣喘病人為研究對象。依變項為門診、急診及住院三部份的醫療資源耗用（包含總醫療費用及每日藥費），自變項為醫療院所與醫師之特質，而控制變項則為病患特質。所使用的主要統計方法為線性複迴歸分析，以檢定依變項與自變項間的關聯性。結果：分析結果顯示，在門診部份，公立醫院在門診總醫療費用及門診每日藥費均較其它屬性的醫療院所為高。然而，醫師特質對醫療資源耗用無顯著性的影響力。在住院部份，公立醫院、醫學中心及小兒科醫師變項對住院總醫療費用有顯著性的影響力。在急診部分，醫師專科年資及醫師年齡變項對急診每日藥費有顯著性的影響力。結論：本研究發現，醫療院所與醫師特質和兒童氣喘患者的醫療資源耗用有關聯性。最後，依據研究發現本研究提出兩項建議：1.分析結果顯示就診科別為小兒科或是醫師屬小兒科專科醫師者會有較低的醫療資源耗用，建議後續研究可利用診療結果面的資料以驗證前述結果是否因為小兒科醫師對於兒童氣喘用藥與診斷較為有效之故。2.基層醫療院所醫師應扮演家庭醫師的角色，以提升民眾的福祉。

關鍵字

醫療資源耗用 ； 兒童氣喘

並列摘要

Objectives: Asthma is a chronic inflammatory disorder of the airways and usually requires long-term medication control to prevent further exacerbations. Children have smaller airways than do adults and that makes asthma especially serious for them; consequently, they utilize more medical resources. Therefore, children with asthma are an important study population with regard to the effective utilization of medical resources. The purpose of this study was to explore the impact of the attributes of medical care organizations and physicians on medical resource utilization by children with asthma.Methods: The data for this study were retrieved from the 2010 National Health Insurance Research Database. Subjects of the study were children with asthma. Outcome variables were total medical expenditures and daily medication expenses for inpatient, outpatient, and emergency room services. Predictive variables were characteristics of medical care institutions and physicians, while patient characteristics served as control variables. Multiple regression analysis was the main statistical method used to evaluate the relationships between predictive and outcome variables.Results: For outpatient services, medical resource utilization of public medical care institutions was higher than that of other facilities. Physician characteristics exerted insignificant effects on medical resources utilization. With respect to inpatient services, public medical care institutions, medical centers and pediatricians were significantly related to total inpatient medical expenses. For emergency room services, the variables of specialist seniority and patient age were associated with daily medication expenses.Conclusions: This study demonstrated that attributes of medical care organizations and physicians were associated with medical resource utilization by children with asthma. Based on these research findings, we propose that future research explore the underlying reasons for the finding that pediatricians utilized fewer medical resources when compared to other physicians. Primary care physicians should be encouraged to play the role of ”family doctor” in order to safeguard the public's health.

並列關鍵字

Medical resource utilization ； Childhood asthma

參考文獻

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