不同照護型態癌末病人之醫療處置與醫療費用分析

Treatments and Expenditures Associated with Different Care Mode in cancer Patients

李勝凱(Sheng-Kai Li)

指導教授 ： 湯澡薰

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(2006年)

摘要

癌症為台灣地區第一大死因，且每年死於癌症的人數也逐年遞增。安寧療護以人性化的照護方式，提供病患支持性照顧、舒適的護理及維持其原有生活品質。本研究旨在探討接受安寧療護與傳統照護兩種照護型態之癌末病患，對醫療費用與醫療處置利用之差異。 本研究對象為2000年10月1日至2004年12月31日期間，中央健保局住院醫療費用明細檔中病患住院死亡者。病患依照護型態分為兩種類型，病患臨終時接受安寧療護住院服務為研究之實驗組，而臨終時接受傳統住院服務為研究之控制組，控制組再依是否為安寧療護醫院分為兩組，「傳統一」為在安寧療護醫院接受傳統照護者，「傳統二」為在非安寧療護醫院接受傳統照護者。分別串聯兩組病患健保門診、住院費用檔與醫令檔，比較臨終前醫療費用與醫療處置利用之差異。 研究結果顯示，男、女前五大癌症死因個案總計34,587人，接受「安寧療護」照護共6,694人，接受「傳統照護」共27,893人。在控制了病患和醫療機構特質等影響因素後，照護型態別為癌症醫療費用與醫療處置的影響因素。「安寧療護」仍具有費用節省性，且在控制了影響因素後，接受「安寧療護」照護病患仍較不偏好接受手術、化學治療和抗癌藥物。接受「傳統二」照護病患的醫療費用高於接受「傳統一」照護病患的醫療費用。而接受「傳統一」和「傳統二」照護病患則顯著偏好接受手術、化學治療和抗癌藥。在放射線治療利用上，在控制了影響因素後，結直腸癌和肝癌接受「安寧療護」照護之病患較偏好使用放射線治療，而接受「傳統一」和「傳統二」照護病患則顯著較不偏好於使用放射線治療。 整體而言，安寧療護確實有達到有節省成本和減少醫療處置利用的成效。建議對相關法令與給付給予適度修正，並支持安寧療護的發展，加強醫學教育與民眾教育，讓安寧療護的觀念深植人心。

關鍵字

癌症 ； 安寧療護 ； 醫療處置 ； 醫療費用

並列摘要

Objective: Cancer has become the leading cause of the death in Taiwan since 1982, and cancer deaths have increased noticeably in recent years. Hospice care provides a support care and high quality of care at the end of life. The purpose of this study is to compare the treatment modules and expenditures between hospice and conventional care for terminal cancer patients. Methods: The study subjects were terminal cancer patients who deceased during their hospital admission during October 1 2000 to December 31 2004. Data was retrieved from Inpatient Expenditures by Admissions files released by the National Health Research Institutes. The study subjects were divided into two groups in terms of care mode. The study group was patients hospitalized in the hospice care (HC) unit. The control group was patients receiving conventional care (CC). The control group was further separated into two groups according to their setting, one is conventional care in a hospital with hospice care services (CC_H), and the other is conventional care in a hospital without hospice care services (CC_NH). We then trace these patients’ expenditures and treatment modules in all their outpatient, emergency visits and inpatient care up to three months before death. The data sources were from Inpatient Expenditures by Admission file, Ambulatory Care Expenditure by Visits file, Details of Inpatient Orders file, and Details of Ambulatory Care Orders file. Results: Results of this study showed that there were 34,587 decedents for the male’s and female’s top five leading causes of cancer death. Among these deceased patients, there were 6,694 decedents who chose HC and 27,893 decedents who chose conventional care (include CC_H and CC_NH). Medical expenditures and treatment modules were associated care mode, after controlling for patients demographic characteristics and institutional factors. HC had great savings over conventional care. Patients in HC compare with patients in CC were less likely to receive surgery, chemotherapy and anti-neoplasm drug. Among those patients in conventional group, CC_H patients had higher expenditures and were more likely to undergo surgery, chemotherapy and taking anti-neoplasm drug. HC Patients with colorectal and lung cancer tended to receive radiotherapy compare with CC_H and CC_NH patients. Conclusion: Hospice care consumed less health care resources and had cost-saving benefit. Related policy should be implemented to promote the acceptance of hospice care among patients/family and medical staff in Taiwan.

並列關鍵字

cancer ； hospice ； treatments ； expenditures

參考文獻

安寧緩和醫療條例(2001)。安寧療護， 6(3)，42-44。

邱艷芬(1997)。全膝關節置換手術之醫療品質評估與緊要路徑之探討:中央健康保險局委託研究計畫。 陳佳琪(1999)。健保論病例計酬門診手術與住院手術醫療資源耗用分析-以疝氣修補術為例。中國醫藥學院醫務管理學研究所碩士論文。 陳淑怡(1998)。老人生命末期健保住院醫療費用之分析。國立陽明大學公共衛生研究所碩士論文。 曾淑芬(1999)。從醫院管理角度論全民健保資料庫。中華公共衛生雜誌，18(5)，363-372。

賴允亮(2000)。台灣安寧緩和醫療。內科新知，4(3)，30-37。

藍祚運(2003)。台灣人口的老化對未來健康面的影響。台灣衛誌，22(3)，237-244。

蘇喜、黃月桂、李丞華、郝宏恕、湯靜怡(1997)。健保資料庫在醫療資源耗用及醫療品質偵測上之功用。中華公共衛生雜誌，16(6)，527-537。