- 期刊
Covid-19三級警戒對重大傷病患者醫療利用的影響評估
The impact of the level 3 Covid-19 alert on the medical utilization of patients with major illnesses
摘要
目的：本研究以某醫學中心為例，運用季節性整合移動平均自迴歸（Seasonal Auto-Regressive Integrated Moving Average model, SARIMA）模型檢測Covid-19疫情三級警戒對重大傷病患者醫療利用之影響，以提供衛生當局未來施政參考。方法：以重大傷病每日「入院人次佔比」、「平均住院日」、「平均每人次自費醫療費用」、「平均每人次健保醫療費用」四個變數，將各變數觀察值分為三級警戒期間73天、警戒前73天、警戒結束後73天，使用SARIMA模型檢測各變數在三個期間資料的穩定性，及期間的相關趨勢，並預測警戒後的恢復情形。結果：在重大傷病供床能力上，警戒期間平均每日就醫入院人次佔比15.79%，明顯低於警戒前的21.79%及警戒結束後的19.96%。在住院天數方面，警戒期間重大傷病入院平均住院日拉長至11.68日，明顯高於警戒前的8.23日及警戒結束後的9.69日。在醫療費用方面，警戒期間重大傷病入院平均每人次自費55,059元、健保149,533點，明顯高於警戒前平均每人次自費44,021元、健保94,337點及警戒後入院者平均每人次自費56,138元、健保124,507點。且無論在供床能力、住院天數或醫療費用上，警戒期間的穩定性均較警戒前後要來的低。結論：醫學中心負擔重度急救責任後送醫療，在三級警戒的事件下，衛福部規定醫學中心應提撥至少急性病床的1/10作為收治新冠肺炎的專責病床。如何同時確保重大傷病患者醫療安全、品質及就醫的穩定，值得詳細規劃。
並列摘要
Objectives: In a certain hospital, we use the Seasonal Auto-Regressive Integrated Moving Average model (SARIMA) model to detect the impact of level 3 Covid-19 alert on the medical utilization of patients with major illnesses as to provide a reference for the future policy of health authorities. Methods: Our data was four variables of the number of inpatient rates (number of major illnesses inpatient/number of all inpatient) by major illnesses, along with an average length of hospital stay (LOS), out-of-pocket medical expenditures, and National Health Insurance (NHI) medical expenditure. The data of each variable is divided into three period levels: 73 days of the alert period, 73 days before the alert period, and 73 days after the alert period. The SARIMA model is used to detect the stability and the trend of data, and forecast recovery after the end of the alert. Results: To study the capacity of inpatient beds for major illnesses during the pandemic, the inpatient rate in the alert period was 15.79%, significantly lower than before the alert period of 21.79% and after the alert period of 19.96%. The average LOS in the alert period was 11.68, significantly higher than before the alert period of 8.23 days and after the alert period of 9.69 days. In average medical expenditures, out-of-pocket was 55,059NTD and NHI 149,533 points in the alert period, significantly higher than before the alert period of 44,021NTD and NHI 94,337 points and after the alert period of 56,138NTD and NHI 124,507 points. However, inpatient of bed capacity, the average LOS and medical expenditures in the alert period were significantly lower stability. Conclusions: The medical center is responsible for emergency medical services. In the event of a level 3 Covid-19 alert by the Ministry of Health and Welfare, the medical center should be appointed to assign at least 1/10 of the emergency beds for treating COVID-19 cases. Meanwhile, ensuring major illnesses inpatient be the safety, quality and stability of medical treatment is worthy of comprehensive planning.