糖尿病視網膜病變病患眼科之醫療資源耗用探討

The Study of the Ophthalmic Medical Utilization in Patients with Diabetic Retinopathy in Taiwan

王英良(Ying-Liang Wang)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2015年)

摘要

目的:糖尿病於2005年已提升變成國人十大死因之第四位，而糖尿病視網膜病變是糖尿病病患不易察覺卻易造成失明的最嚴重併發症之一。台灣糖尿病病患在18歲以上的盛行率約7.1%，40歲以上則約為10%。國人糖尿病病患之視網膜病變的盛行率則為26.5％，2013年花費在糖尿病的總醫療費用為230.3億健保點數，占當年總健保醫療費用3.9%，較前年成長近11%。眼底鏡檢查是檢測糖尿病視網膜病變最直接的方法。2011年中央健保局醫療品質資料發現國人眼底檢查率只有30.4%遠低於國外研究的69%。過去，國內相關於糖尿病視網膜病變之研究上，鮮有在糖尿病視網膜病變著重在眼科之醫療耗用上。因此，期藉由健保資料庫資料分析，探討糖尿病視網膜病變病患眼科的醫療耗用情形。
方法: 本研究使用回溯性方法設計，利用全民健保資料庫「2010年百萬歸人檔」為基礎，研究對象為2003-2008年診斷為糖尿病視網膜病變（ICD-9-CM主診斷碼為250.50，250.51，250.52、250.53或362.01，362.02）病患，病患將依疾病程度分為無糖尿病視網膜病變(NDR)、增值性糖尿病視網膜病變(PDR)、非增值性糖尿病視網膜病變(NPDR)三組追蹤其五年眼科醫療耗用，並以卡方、ANOVA、線性複迴歸分析，比較病患在眼科的醫療耗用的差異。
結果:本研究擷取符合條件人數為10,918人，女性5,922(54.24%)人，男性4,996(45.76%)人，平均年齡為61.20?b11.13歲。醫療耗用方面，總平均門診次數為16.33?b19.02次，總平均門診費用為新台幣16,857.57?b24,162.64元，總平均住院次數為0.23?b1.69次，總平均住院費用為新台幣2,362.65?b13,987.88元，總平均眼底檢查次數為2.23?b3.68次，總平均眼底檢查費用為新台幣121.47?b209.52元，總平均雷射手術次數為0.47?b1.56次、總平均雷射手術總費用新台幣1,633.45?b5,338.30元，以及總平均醫療費用(門診及住院)為19,220.22?b30,506元。在不同疾病嚴重程度中，無糖尿病視網膜病變人數為2,458人(22.51%)、增值性糖尿病視網膜病變人數為3,070人(28.12%)、非增值性糖尿病視網膜病變人數為5,390人(49.37%)，其5年平均總眼底檢查率分別為1.89?b3.45次、2.17?b3.39次與2.61?b4.27次。
結論：本研究針對無糖尿病視網膜病變、增值性糖尿病視網膜病變、非增值性糖尿病視網膜病變病患進行五年資源耗用探討，發現無論在眼科門診次數、眼科門診總費用、眼科住院天數、眼科住院總費用、眼底鏡檢查次數、眼底鏡檢查總費用、以及眼科總醫療費用皆呈現顯著性差異。而在5年平均總眼底檢查率方面，相對於文獻建議檢查次數則偏低，特別是增值性糖尿病視網膜病變。隨著糖尿病視網膜病變越來越嚴重，糖尿病患在眼科的醫療耗用也逐漸加重，不僅病患的生活品質下降，也將使健保財務窘境日益加重。因此若能透過醫師對於糖尿病視網膜病變使用眼底鏡檢查的頻率增加，是提升病患醫療品質與降低醫療費的重要目標。

關鍵字

增值性視糖尿病視網膜病變；糖尿病視網膜病變；醫療耗用；眼底鏡檢查

並列摘要

Purpose: Diabetes has been raised to the fourth leading cause of death of people in 2005 in Taiwan, and then diabetic retinopathy in diabetic patients is difficult to be detected but easy to cause blindness and of serious complications. In Taiwan, the prevalence of diabetes in patients over 18 years of 7.1% and over 40 years is around 10%. The prevalence of retinopathy in patients with diabetes was 26.5%. Spending in total health care costs for diabetes was around 23 billion reimbursed points accounting for 3.9% of total Bureau of National Health Insurance (BNHI) medical care costs in 2013, compared with the previous year growth of nearly 11%. Funduscopic examination is the most direct way to detect diabetic retinopathy. According to the 2011 BNHI's data found that the quality of care people funduscopic examination rate of only 30.4% is far below the 69% foreign research。In the past, studies on diabetic retinopathy rarely focused on eye care consumption. So, we are hoping to search from the database of Bureau of National Health Insurance (NHIRD) to analyze for patients with diabetic retinopathy medical consumption situation in ophthalmology。
Methods:This study used retrospective methods design, the use of basis of "the 2010 archives of millions of people", got from the database of Bureau of National Health Insurance (NHIRD), search for who were from 2003 to 2008 newly diagnosed patients with diabetic retinopathy (ICD-9-CM main diagnosed code are 250.50, 250.51, 250.52, 250.53, 362.01 and 362.02). Patients are divided into three groups of pre-diabetic retinopathy (NDR), proliferative retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) to track their following five years retinopathy ophthalmic medical consumption, and using Chi-square, ANOVA and linear multiple regression analysis to compare the differences of varying degrees of diabetic retinopathy in ophthalmology resource consumption.
Results: In this study had made a total of 10,918 qualified people, including 4,996 male and 5,922 female. The average age was 61.20?b11.13 years old. Total average number of outpatient was 16.33?b19.02 with total average cost of NTD16,857.57?b24,162.64. And total number of hospitalizations was 0.23?b1.69 with the overall average hospitalizations cost of NTD 2,362.65?b13,987.88. The total average number of fundus examination was 2.23?b3.68 with average total cost of NTD121.47?b209.52. The number of overall average laser surgery was 0.47 times with overall average total cost of NTD1,633.45?b5,338.30. Finally, the total cost of medical utilization was NTD19,220.22?b30,506. Accordong to diabetic retinopathy severity, there patients are divided into NDR (n=2,458), NPDR(n=5,390) and PDR(n=3,070), whom 5-year average number of fundus examinations are 1.89?b3.45, 2.17?b3.39 and2.61?b4.27, respectively. Conclusion: In the study, we analyzed their following five-year ophthalmic medical resource consumption of diabetic patients with pre-diabetic retinopathy, Proliferative diabetic Retinopathy and Non-proliferative diabetic Retinopathy, that found the frequency number of eye clinic, the total cost of eye clinic, hospitalization days of ophthalmology, total hospitalization costs of ophthalmology and total medical costs in ophthalmology that showed all statistical significance. With the progression of diabetic retinopathy severity, which is also gradually increased in ophthalmology medical consumption, not only makes the quality of life of patients decreased, more so health insurance is increasing financial predicament. Therefore, if the increase in diabetic retinopathy patients pay attention to the effects on vision, as well as increased frequency of diabetic retinopathy ophthalmoscope examination, it will be able to delay and improve patient vision deterioration; and so, will be able to reduce the country's overall health costs and socio-economic burden in the future

並列關鍵字

diabetic retinopathy；utilization；ophthalmoscope examination

參考文獻

參考文獻

中文部份

中央健康保險署(2013)。全民健康保險滿意度調查。全民健康保險雙月刊第105期(9月號)。中央健康險局電子報網頁。取自http://www.nhi.gov.tw/epaper/ItemDetail.aspx?DataID=3462&IsWebData=0&ItemTypeID=7&PapersID=302&PicID=

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