氣喘住院病患特性及醫療費用之影響因子

Patients' Characteristics and Factors Influencing Medical Utilization in Asthma Hospitalizations

張偉斌(Wei-Pin Chang) ； 游漢欽(Hann-Chin Yu) ； 尤鐘賢(Jhong-Sian Yu) ； 林綉玲(Hsiu-Ling Lin) ； 彭慧美(Hui-Mei Peng) ； 吳忠敏(Chun-Ming Wu)

《北市醫學雜誌》 11卷2期 (2014/06) Pp. 146-160

https://doi.org/10.6200/TCMJ.2014.11.2.04

摘要

目的：分析國人氣喘住院病患特性，並找出氣喘住院病患醫療費用高低的影響因子。方法：使用健保資料庫分析1997-2008年資料，將住院醫療費用清單檔（DD）與醫事機構基本資料檔（HOSB）串連，選取研究對象為ICD-9CM為493.x病患，排除性別、生日空缺等資料，並以SPSS 18.0進行分析。結果：本研究氣喘住院之總個案為24,398人次，其中男性為12,894人次，女性為11,504（約47.2%）；平均年齡約為43.35歲，每人次平均有2.25個共伴疾病，其中，超過一半的氣喘住院病患有一個以上的共伴疾病。平均住院天數為8.60天，每次住院的平均醫療費用為31,243元。另外以邏輯斯迴歸分析影響醫療費用高低因子為就醫層級為醫學中心（OR=1.610）、就醫科別為骨科（OR=1.907）、共伴疾病數越多（1個：OR=1.541、2個：OR=2.040、3個：OR=2.967、4個：OR=4.669）、就醫季節（夏OR=1.106）、有無手術處置（OR=2.239）、察爾森指標（OR=1.226）、低收入戶（OR=1.694）及罹患重大傷病者（OR=2.427）的氣喘住院病患的醫療費用皆為較高的情形。結論：研究結果顯示，影響氣喘住院費用的因素，共有年齡、就醫層級、就醫科別、共伴疾病數、就醫季節、手術處置、察爾森指標、低收入戶與重大傷病等因素。除此之外，若病患擁有其他共伴疾病時，亦會大幅增加醫療費用如肺炎，此部分是需要政府擬訂相關政策來協助醫院進行醫療費用的管控。

關鍵字

氣喘 ； 醫療利用 ； 住院病人

並列摘要

Objective: This study examined the characteristics of asthma inpatient visits and factors influencing the medical utilization in Taiwan. Methods: Claim data of the National Health Insurance Database, Taiwan was used in this study. Asthma subjects were defined as those with an ICD9-CM code of 493.x. Inpatient cost by admission files (DD) and hospital primary registry files (HOSB) between 1997 and 2008 were retrieved. Result: A total of 24,398 asthma inpatient visits including 12,894 male visits and and 11,504 female visits were analyzed. The average age of the sample was 43.35 years. The average number of comorbidities/complications was 2.25; more than half of hospitalized asthma inpatient visits had one comorbidity/complication at least. The average length of stay was 8.3 days and the average hospitalization cost was NT 31,243. Further logistic regression model showed that factors contributing to higher medical expenditure were treatment in medical center (OR=1.610), treatment in orthopedics (OR=1.907) , more comorbidities/complications (one:OR=1.541, two:OR=2.040, three:OR=2.967, four:OR=4.669), higher Charlson Comorbidity Index score (OR=1.226), summer season (OR=1.106), surgical operation (OR=2.239), low-income family (OR=1.694) and with catastrophic illness mark (OR=2.427). Conclusion: Our study demonstrated that hospital level, specialist type, comorbidities/complications, season, surgical operation, Charlson Comorbidity Index Score, lowincome family, and patient with catastrophic illness mark affected the hospitalization cost of asthma inpatients. Further policies should be developed to control the increment of the expenses.

並列關鍵字

asthma ； medical utilization ； inpatient