台灣全民健保制度下血液成分使用趨勢及其影響因素之研究

Study of the Trend and Influencing Factors of Blood Components Usage under National Health Insurance in Taiwan

盧啟德(Chi-Te Lu)

指導教授 ： 張肇松

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2011年)

摘要

研究目的
台灣醫療用血主要由台灣血液基金會所轄捐血中心供應，且多以健保給付為主。藉由探討全民健保庫特約醫療機構申報之用血資料，瞭解實際醫療用血概況。
本研究主要目的如下：
一、探討台灣醫療機構血液使用情形與使用趨勢。
二、比較台灣與國際間血液成品使用情形。
三、探討影響血液成分醫療資源利用之相關因素。
研究方法
本研究屬於縱貫性研究，採用回溯性次級資料分析，以2003年至2008年中央健康保險局特約醫療機構申報之全民健保資料庫中，使用血液成品之住院及門診病人為研究對象，探討病患之人口學特質、醫院特質、疾病特質是否影響血品使用情形。
本研究使用SPSS 18.0 for Windows中文版套裝軟體，以獨立樣本T檢定、單因子變異數分析、單變量變異數分析，進行描述性及推論性統計。
研究結果
台灣紅血球類成品每千人口數使用數量45.4 units，高於英國、挪威、法國，低於丹麥、芬蘭、德國、瑞典、美國。血漿類血品每千人口數使用數量30.4units，高於法國、英國、芬蘭、挪威、丹麥、瑞典、美國、德國。
在台灣「紅血球血漿使用量比」為1.49，低於大部分歐美國家。以健保分局別比較，紅血球血漿使用量比以高屏分局最高，台北分局最低。以醫療機構層級別比較，紅血球血漿使用量比依序為地區醫院、區域醫院、醫學中心（1.4~1.7、
1.0~1.3、0.9~1.1）。
就醫科別之紅血球類成品使用量排名依序為內科、腸胃內科、骨科、胸腔內科、外科；血漿類成品使用量依序為腸胃內科、外科、胸腔內科、內科、血液腫瘤科；血小板類成品使用量依序為血液腫瘤科、腸胃內科、外科、胸腔內科、內科。
疾病類別之紅血球類成品使用量排名，以消化系統疾病（17.86％）最高，其餘依序為腫瘤（17.34％）、呼吸系統疾病（12.23％）、損傷及中毒（11.51％）、循環系統疾病（10.47％）。血漿類血品使用量排名，以消化系統疾病（23.80％）最高，其餘依序為腫瘤（21.13％）、呼吸系統疾病（15.33％）、循環系統疾病（10.27％）、損傷及中毒（8.10％）。血小板類成品使用量排名，以腫瘤（32.45％）最高，其餘依序為消化系統疾病（14.05％）、循環系統疾病（10.12％）、呼吸系統
疾病（9.13％）、血液及造血器官疾病（6.62％）。
研究結果顯示血品使用量與病患之人口學特質、醫院特質、疾病特質有關，血液成品使用量會受上述因素影響。
結論與建議
研究結果顯示台灣血液資源利用及血液成品用血趨勢與疾病類別、就醫科別、地區有關。台灣紅血球血漿使用量比明顯低於歐美國家，顯示台灣血漿可能有使用過量情形，尤其在高屏分局特別顯著。本研究所得之血液成品使用結果，
可提供實證數據，作為捐血中心制定血源規劃政策參考。

關鍵字

血液成品 ； 醫療資源利用

並列摘要

Objective : The blood components were primarily supplied by the six Blood Centers of Taiwan Blood Services Foundation, and reimbursed by national health insurance in Taiwan. The purposes of this study are first, to investigate the blood utilization and its trend in Taiwan, second, to peform an international comparison between Taiwan and other countries. Finally, this study also investigate the influencing factors of blood
components usage.
Materials and Methods : A longitudinal, retrospective analysis of secondary data from NHI, including the inpatient and outpatients database from 2003 to 2008.The demographic characteristics of the patients, hospital characteristics, disease diagnosis affecting the use of blood components were analyzed. Statistical analysis including descriptive analysis, student t-test, ANOVA, and univariate analysis were performed
using SPSS Statistics 18.0 Software for Windows Chinese Edition package.
Results : To peform a comparison the blood components usage, calculating the units of blood transfusion per 1,000 population between Bureau of National Health, the first place of RBC components usage was Eastern Region Branch（59.2units）, and the last place was Taipei Branch（44.0units）. The first place of plasma components usage was Kao-Ping Branch（40.9units）, and the last place was Taipei Branch（23.4units）. RBC components usage trand was stable growth（-1.31％、-1.50％、3.67％、5.69％）, plasma components usage trand was on the downside（-10.60％、-18.58％、-8.15％、-10.16％）, platelet components usage trand was ascending（1.89％、8.92％、22.58％、
29.64％） from 2004 to 2008 in T aiwan.
The mean units of RBC usage per 1000 population in Taiwan was 45.4 units which was higher than Britan, Norway, and France and lower than Denmark, Finland, Germany, Sweden, and America., The mean units of plasma usage per 1,000 population was 30.4 units in Taiwan, which was higher than France, Britain , Finland,
Norway, Denmark, Sweden, America, Germany.
The mean RBC/FFP ratio in Taiwan was 1.49 which was lower than most western countries.The plasma usage varied by district, which was highest in Kao-Ping Branch and lowest in Taipei branch. The RBC/FFP ratio of district hospitals, regional
hospital, and medical center were 1.4 to 1.7, 1.0 to 1.3, and 0.9 to 1.1, respectively.
In order of RBC components usage were Internal Medicine, Gastrointestinal Medical, Orthopedics, Chest Medical Department, Surgery on divisions. In order of plasma components usage were Gastrointestinal Medical, Surgery, Chest Medical Department, Internal Medicine, Hematology and Oncology. In order of platelet components usage were Hematology and Oncology, Gastrointestinal Medical,
Surgery, Chest Medical Department.
The RBC usage by diseases showed the highest in diseases of the digestive system (17.86％), followed by neoplasms (17.34％), diseases of the respiratory system (12.23％), injury and poisoning(11.51％) , diseases of the circulatory system (10.47％). The plasma usage by disease showed the highest in diseases of the digestive system (23.80％), followed by neoplasms (21.13％), diseases of the respiratory system (15.33％), diseases of the circulatory system (10.27％), injury and poisoning (8.10％). The platelet usage by diseases showed the highest in neoplasms (32.45％), followed by diseases of the digestive system (14.05％), diseases of the circulatory system (10.12％), diseases of the respiratory system (9.13％),
disease of the blood and blood-forming organs(6.62％).
The results show significant differences between the blood usage with demographic characteristics of the patients, hospital characteristics, disease diagnosis
affecting the use of blood components.
Conclusion and Suggestion : Our results showed the utilization and trend of blood components usage in Taiwan varied by diseases, department, and district. The RBC/FFP ration in Taiwan was significantly lower than western countries, which implicate the potential overuse of plasma in Tawan, especially in Kao-Ping Branch. This results about the blood component usage provide a clinical evidence for blood
recruitment policy-making of blood donation center in Taiwan.

並列關鍵字

blood components ； medical resource utilization

參考文獻

中文文獻

1. 中華血液基金會（2003）。中華血液基金會2003年報。中華血液基金會。

2. 中華血液基金會（2004）。中華血液基金會2003年報。中華血液基金會。

3. 台灣血液基金會（2005）。台灣血液基金會2004年報。台灣血液基金會。

4. 台灣血液基金會（2006）。台灣血液基金會2005年報。台灣血液基金會。