健保IC卡對電腦斷層攝影及磁振造影利用之影響
—以台灣地區醫學中心及區域醫院為例

目的：　　醫療費用支出逐年上漲是各國健保面臨的共同問題，而高科技醫療的使用被視為造成醫療費用上漲的重要因素之一。本研究係探討93年健保IC卡上線導入全民健康保險，並於 94年１月１日政策實施健保IC卡重要醫令－電腦斷層攝影(CT)、磁振造影(MRI)登錄上傳後，是否會因民眾在就醫時，醫療院所可從健保IC卡就診紀錄中了解該病患重大醫令檢查執行情形，而減少CT及MRI的重複使用，進而降低醫療費用支出。研究目的：(1)比較醫學中心、區域醫院CT及MRI在健保IC卡實施重要醫令登錄上傳前後門診利用度之差異(2)比較醫學中心、區域醫院CT及MRI在健保IC卡實施重要醫令登錄上傳前後住院利用度之差異(3)比較醫學中心、區域醫院CT及MRI在健保IC卡實施重要醫令登錄上傳前後門診醫療費用之差異(4)比較醫學中心、區域醫院CT及MRI在健保IC卡實施重要醫令登錄上傳前後住院醫療費用之差異(5)探討醫學中心、區域醫院CT及MRI在健保IC卡實施重要醫令登錄上傳前後醫療費用改變之相關因素。方法：本研究以台灣地區中央健康保險局之納保者於93及94年在醫學中心或區域醫院門診與住院之病患為研究對象。另從對應年之國家衛生研究院全民健康保險研究資料庫篩選符合研究對象的資料庫系統抽樣檔(門診500抽1；住院20抽1)為研究樣本，以進行健保IC卡重要醫令登錄上傳實施前後門診、住院之CT及MRI利用度與醫療費用之比較及統計分析。結果：研究顯示，實施健保IC卡重要醫令登錄上傳後，醫學中心住院之CT、MRI醫療利用度從16.8%降至16.2%；區域醫院之CT、MRI醫療利用度從14.2%降至13.4%，二者均達統計上顯著差異；另在醫療費用比較方面，醫學中心住院醫療費用佔率從2.34%降至2.15%；區域醫院住院醫療費用佔率從2.44%降至2.28%，亦均達統計顯著差異。結論與建議：　　本研究中有關醫學中心與區域醫院CT、MRI之利用度與費用情形雖僅在住院部份呈現顯著下降，而在門診部分的CT、MRI之利用度與費用情形降低成果不明顯，但從88-94年的CT、MRI醫療利用與費用情形成長趨勢圖中，已稍可發現有減緩象現，顯示實施健保IC卡重要醫令登錄上傳，應是一項重要減低醫療費用上漲的政策。

關鍵字

健保IC卡(NHI IC card) ；電腦斷層攝影(CT) ；磁振造影(MRI)

並列摘要

OBJECTIVE: 　　The continual increase in medical expenses year by year is a common problem that is facing many countries, and the utilization of hi-tech medical products is considered to be one of the major causes . This study is to discuss whether the introduction of IC card into National Health Insurance in 2003 and the implementation of the registration and upload of important physician orders such as orders on Computerized Tomography(CT) and Magnetic Resonance Imaging(MRI) after January 1, 2004 has decreased the repetitive utilization of CT and MRI. The study purpose is to lower the medical expenses since medical clinics can learn from medical records in the National Health Insurance IC cards the execution information on important physician orders of patients when they consult a doctor. RESEARCH PURPOSE: (1) Compare the differences in utilization rates of CT and MRI in out-patient clinics before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (2) Compare the differences in utilization rates of CT and MRI in in-patient departments before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (3) Compare the differences in medical expenditures on CT and MRI in out-patient clinics before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (4) Compare the differences in medical expenditures on CT and MRI in in-patient departments before and after the implementation of the registration and upload of important physician orders into NHI IC cards in medical centers and regional hospitals. (5) Analyze factors relating to the changes in utilization rates and medical expenditures on CT and MRI before and after the implementation of the registration and upload of important physician orders into NHI IC cards. METHODS: This study takes insurants of National Health Insurance in Taiwan who had been out-patients or in-patients of medical centers or regional hospitals during 2004 and 2005 as research objects. In addition, data that match these research objects in the corresponding years were sampled(1-in-500 for out-patients; 1-in-20 for in-patients) from the National Health Insurance Information Database of National Health Research Institute as research samples to carry out comparisons and statistical analysis on the utilization rates of and the medical expenses on CT and MRI for out-patients and in-patients before and after the implementation of the registration and upload of important physician orders into NHI IC cards. RESULTS： The research indicates that, after the implementation of the registration and upload of important physician orders into NHI IC cards, the medical utilization rates of CT and MRI in in-patients in medical centers (the ratio of the number of CT or MRI examinations to the number of in-patient visits at the same medical level in each corresponding year) decreased from 16.8% to 16.2%; the medical utilization rates of CT and MRI in in-patients in regional hospitals decreased from 14.2% to 13.4%. Both achieved statistical significance. While on the aspect of medical expenses, the expenditure rates of CT and MRI to the total medical expenses in medical centers (the ratio of the expenses on CT and MRI examinations to the total in-patient medical expenses at the same medical level in each corresponding year) decreased from 2.34% to 2.15%; the expenditure rates of CT and MRI to the total medical expenses in regional hospitals decreased from 2.44% to 2.28%. Both also achieve statistical significance. RESULTS AND SUGGESTIONS: 　　Despite that significant decreases in the utilization of and the expenses on CT and MRI only appeared in in-patients in relating medical centers and regional hospitals and there was no significant decrease of that in out-patients, however, from the Growth Trend of Utilization and Expenditure of CT and MRI from 1999 to 2005 we can discern signs of slowing-down. These suggest that the implementation of the registration and upload of important physician orders might be an important policy to slow down the growth of medical expenses.