- 學位論文
減少台灣代謝症候群發生率與醫療費用之研究
A Study on Reducing Incidence Rates and Health-care Costs of Metabolic Syndrome in Taiwan
摘要
台灣人之基因特別容易罹患代謝症候群，2009年約有289萬患者，其相關疾病平均每小時奪去4.93條人命，每年有41,944位民眾因而死亡，佔總死亡人數之29.0%。其相關醫療費用是癌症之2.25倍，佔健保局醫療支出之14.5％，2008年已達910億元，每一名患者一年平均至少耗費醫療資源31488元。只要每一名員工因此症而每個月請假一天看病，台灣企業會每年因此損失198億元。 代謝症候群之發病與進展速度，45.5%可藉由飲食與運動而改善。但台灣民眾與政府主管單位所努力之程度，遠不如日本。在健檢項目、篩檢年齡與篩檢頻率以及相關健康行為配套措施方面，都有改進空間。 本研究發現：政府若對20至79歲之17,153,322人，每年提供含代謝症候群篩檢之免費健康檢查，每人費用700元，共需12,007,325,400元。並對所篩檢出之2,937,866位代謝症候群患者，利用工研院所開發之健康管理系統，每人1000元之成本，共需之2,937,866,000元。篩檢與防治一年共需14,945,191,400元，可因此省下代謝症候群之醫療費用共92,507,524,608元，則篩檢與防治之總效益達6.2倍。參照日本要在2015年減少25%病患之目標，則可節省醫療費用每年達227.5億元，超過全面篩檢與防治所需之費用，每年替每位國民節省989元。 為達此目標，筆者建議在近期即【1】將代謝症候群之五項診斷標準均應列入篩檢；【2】對20至79歲之成人，每年都提供免費代謝症候群篩檢；【3】醫療費用給付在基本論人計酬之上，加重論質計酬；【4】全面發展健康個案管理師制度；【5】鼓勵並支助醫院經營代謝症候群病友團體；【6】鼓勵病人自我健康管理，於申報所得稅時，附上前五年之代謝症候群相關檢驗資料，無惡化者可以獲得減稅；【7】比照「文化創意產業發展法」，企業若為其員工所做之健康投資，有成效者可獲得抵稅；【8】考慮以HDL為單一指標。 在長期方面，【1】事在人為，效法1995年所強力推行的「六分鐘護一生」計畫，堅持作正確的事，終能以優良成效獲取各界支持；【2】台灣之醫療費用佔GDP之比例很低，醫療制度必須改革，以提升醫療品質；【3】加強教育，從小讓國民培養自我健康管理之習慣，及正確思考與行為能力。
並列摘要
Taiwanese people are genetically prone to catch metabolic syndrome. The patient number is 2.89 millions now. It kills 4.93 people per hour, and 41,944 people each year，accounting for 29.0% of the total Taiwanese mortality. Each patient spends 31488 NT each year for it at least. Its treatment costs at least 91 billions NT, account for 14.5% of the total Taiwanese health-care cost. If one employee has to ask for a day to leave to the hospital each month, Taiwanese industries have to lose 19.8 billions NT each year. The clinical course of metabolic syndrome can be improved by diet control and exercise for 45.5%. However, the Taiwanese people and the bureaus have not done their best, as the Japanese. There are many deficiencies in health checking items, population, frequencies, and health promotion mechanism. The author finds that if the bureaus freely provide the 17,153,322 people aged from 20 to 79 with general health screening including all the 5 items for diagnosis of metabolic syndrome, each costs 700 NT, totally will costs 12,007,325,400 NT. It can detect 2,937,866 patients with metabolic syndrome。The bureaus can further use a 1000 NT-cost case-management follow-up system, totally cost 2,937,866,000 NT, to improve their lifestyles, it can maximally save the health-care fees up to 92,507,524,608 NT. The benefit to cost ratio of total screening plus prevention to save is 6.2. As the Japanese goal to decrease one quarter of the patient numbness, Taiwan can save health-care cost up to 22.75 billions NT, more than the total screening and prevention cost, or 989NT for each Taiwanese person. To accomplish it, the author recommends the bureaus immediately 【1】include all the 5 items for diagnosis of metabolic syndrome in all health-checking; 【2】freely provide the people aged from 20 to 79 with the checking; 【3】re-design the pay programs with a minor administration fee for each contracted patient and a major values-based wedge for the improved ones; 【4】develop case manager system nationally;【5】 financially encourage the provides to establish patient groups to augment the patients’ behavior change and treatment results;【6】encourage the patients to manage their health by diminish his income tax if he can prove its effect;【7】A company’s fee to improve its employee’s health can be views as cost if it can prove its effect; 【8】use HDL as a single indicator . In the long run, the author recommends the bureaus 【1】insist to do the right thing even the political resistance to change is huge;【2】improve the quality by reforming the health-care system to compensate the low NHE/GDP ratio;【3】enforce the education to build the people’s better behaviors and the thinking ability.