台灣地區乳癌、肺癌、結直腸癌及子宮頸癌之盛行率趨勢暨醫療資源利用之探討

摘要研究目的本研究依據研究背景與動機，提出具體之研究目的如下：一、探討台灣地區四種癌症乳癌、肺癌、結直腸癌及子宮頸癌之盛行率趨勢。二、探討這四種癌症醫療資源利用之差異。研究方法一、本研究採回溯縱貫性研究設計，利用國家衛生研究院釋出之「全民健康保險研究資料庫」，「20萬人承保抽樣歸人檔」之次級資料建立，確立國人1997至2013年間主/次診斷為乳癌，肺癌，結直腸癌及子宮頸癌，探討這四種癌之醫療資源利用（門診費用、住院費用及醫療總費用）。二、使用統計套裝軟體進行資料盛行率趨勢分析，描述性統計及推論性統計分析。研究結果乳癌、肺癌、結直腸癌及子宮頸癌之年盛行率，有隨時間(1997-2013年)上升的趨勢，其中1997年結直腸癌盛行率37.5例(每十萬人口)，逐年增加至2013年盛行率達95.5例(每十萬人口)為本研究四種癌之最高；四種癌之醫療資源利用不論就門診費用、住院費用及總醫療費用在統計學上均是有顯著性差異；1997年至2013年，四癌之總醫療費用比較，乳癌從148705.52±152325.60元增加至254587.63±228504.78元，增加約71%，為四癌醫療總費用之最高。結論與建議研究結果發現四種癌病患之人口學特性、臨床特性、醫院特性與住院天數及費用間皆有顯著的相關。整體而言，初始階段住院天數隨時間有顯著減少的趨勢，顯示醫療科技的進步，醫療水準的提升、健保政策制度的功效，提升了醫療品質，醫療費用卻不斷提升，如何控制逐年高漲的健保費用及資源分配是衛生當局現今重要問題。本研究四種癌症之研究數據，了解不同癌症疾病資源耗用分佈趨勢，將全面的了解不同癌症的經濟負擔，可以提供衛生主管機關對於規劃未來醫療預算以及資源分配擬定之參考，建立完善健保衛生政策，以全民健康為福祉。關鍵詞：乳癌、肺癌、結直腸癌、子宮頸癌、盛行率趨勢、醫療資源利用

關鍵字

乳癌；肺癌；結直腸癌；子宮頸癌；盛行率趨勢；醫療資源利用

並列摘要

Abstract Objectives Based on the research background and motivation, this study proposes the specific research objectives as follows: First, to explore the prevalence of four cancer breast cancer, lung cancer, colorectal cancer and cervical cancer in Taiwan. Second, explore the differences in the utilization of these four cancer medical resources. Methods First,This study adopts the retrospective research design, and uses the “National Health Insurance Research Database” released by the National Institutes of Health to establish the secondary data of “200,000 people underwriting and sampling to the people”, and established the nationals to 1997. In 2013, the main/time diagnosis was lung cancer, female breast cancer, colorectal cancer and cervical cancer. The patient was diagnosed in the first half of the diagnosis and the three time intervals after the diagnosis, and the treatment resources were consumed (the number of hospital stays, Total medical expenses, surgical treatment costs, chemotherapy treatment, radiotherapy costs, hormonal treatment costs), and calculate the trend of medical expenditure and mortality distribution in the initial stage and its influencing factors. Second, Data mining prevalence trend analysis, descriptive statistics and inferential statistical analysis were performed using statistical software packages. Results The prevalence of breast cancer, lung cancer, colorectal cancer and cervical cancer has increased over time (1997-2013) The trend of colorectal cancer in 1997 was 37.5 cases (per 100,000 population), increasing year by year to 95.5 cases (per 100,000 population), the highest of the four cancers in this study; medical resources of four cancers There was a statistically significant difference in the use of outpatient expenses, hospitalization expenses and total medical expenses. From 1997 to 2013, the total medical expenses of four cancers increased, breast cancer 148705.52±152325.60 increased to 254587.63±228504.78, increased About 71% is the highest total cost of medical treatment for four cancers. Conclusion and Suggestion The study found a significant correlation between demographic characteristics, clinical characteristics, hospital characteristics, hospital stay days, and costs for the four cancer patients. Overall, the number of hospitalization days in the initial stage has been significantly reduced over time, showing the advancement of medical technology, the improvement of medical standards, the efficacy of the health insurance policy system, the improvement of medical quality, the continuous improvement of medical expenses, and how to control the health care that is rising year by year. Cost and resource allocation are important issues for health authorities today. This study studies the data of four cancers, understands the distribution trends of different cancer disease resources, and comprehensively understands the economic burden of different cancers. It can provide reference for health authorities to plan future medical budgets and resource allocation, and establish health care hygiene. The policy is to benefit the health of the whole people. Keywords: Breast camcer,Lung cancer,Colon-rectal cancer,Cervical cncer,Prevalence trend,Medical resource utilization