探討重複使用高科技設備趨勢分析及醫療資源耗用之研究－以CT及MRI為例

研究目的一、探討重複使用高科技設備，其醫療資源耗用之長期趨勢分析。二、探討重複使用高科技設備，其病患特性與醫療特性對醫療資源耗用之重要影響因素。研究方法本研究採回溯性縱貫性研究設計，利用國家衛生研究院「全民健康保險研究資料庫」之「2000年百萬承保抽樣歸人檔」次級資料，醫療資源耗用包括門診檢查費用、住院檢查費用、平均檢查費用、重複檢查次數，及探討病患特性(性別、年齡、疾病種類、14日內重複檢查)與醫療特性(醫師年資、就醫科別、醫院層級、醫院權屬)對醫療資源耗用之影響。以SPSS 19.0及STATS 10.0統計套裝軟體工具進行資料整理及分析，本研究利用廣義估計方程式(Generalized estimating equations,GEE)探討1997年至2010年(區分為四個期間)重複使用高科技設備，醫療資源耗用之長期趨勢分析及醫療資源耗用之重要影響因素。研究結果一、門診檢查費用及住院檢查費用，隨著時間的增加有上升的趨勢(P<0.001)。二、平均檢查費用第第一期至第三期顯著上升，第四期較第三期顯著下降；重複檢查次數除第二期較第一期無顯著差異外，第三期較第二期顯著下降，第四期較第三期顯著上升。三、在病患特性方面：「性別」與平均檢查費用顯著相關；「年齡」、「疾病種類」與門診、住院、平均檢查費用及重複檢查次數顯著相關；「14日內重複檢查」與門診、住院檢查費用及重複檢查次數顯著相關。四、在醫療特性方面：「醫師年資」與門診檢查費用顯著相關；「就醫科別」與門診、住院檢查費用及重複檢查次數顯著相關；「醫院層級」與門診、住院、平均檢查費用及重複檢查次數顯著相關，另醫院權屬對醫療資源耗用無顯著相關。結論與建議本研究結果顯示重複檢查CT或MRI之醫療費用會隨著時間的增加而顯著上升，且病患特性與醫療特性對於醫療資源耗用有顯著影響。健保局為管控其利用，已陸續以重要醫令即時報備系統、特定檢查資源共享試辦計畫、健保IC卡登錄重要指令項目、全民健康保險檔案分析審查異常不予支付指標及處理方式、健保IC卡登錄及上傳資料品質實施方案、全民健康保險醫療費用審查注意事項等方式管控CT及MRI，因健保局刪減費用，可能造成醫院誘導民眾轉為自費檢查，為真正抑制醫療檢查費用的成長，建請確立檢查規則，明確定義在何種狀況下，得進行電腦斷層造影、磁振造影等檢查。

關鍵字

重複使用；全民健康保險；醫療資源耗用；廣義估計方程式GEE

並列摘要

Purpose 1.To explore long-term trend of medical resource utilization in patients with reuse high-tech equipment. 2.To explore patient characteristics and medical characteristics of medical resource utilization in patients with reuse high-tech equipment. Research Methods The report adopts retrospective and longitudinal design to analysis, which use “Insurance Beneficiaries million Files in 2000” of National Health Insurance Research Database in National Health Research Institutes (NHRI). Medical resource utilization includes outpatient examination fees, inpatient examination fees, average examination fees, repeat inspections and patient characteristics in gender, age, type of disease and repeat examination within 14 days. And the medical characteristics are physician seniority, clinical specialty, hospital level, and hospital ownership. The report investigate medical resources the long-term trend analysis of medical resource utilization and important factors in 1997-2010 (divided into four time periods) repeated use high-tech equipment by generalized estimating equations(GEE). Data analysis was performed by using STATA statistical software version 10.0 and SPSS statistical software version 19.0. Results 1. The examination fees of both outpatient and inpatient as time increases upward trend (P <0.001). 2. The average costs of examination from the first time period to the third time period are increased significantly, but the fourth time period significant decline compared to the third time period. According to repeat inspections, the second time phase shows no significant difference compared with the first time phase; the third time phase decreased significantly compared to the second time phase; the fourth time period significantly increases compared to the third time period. 3.According to the patient characteristics, the gender is significantly associated with the average inspection costs. The Age and disease type are significantly associated with outpatient, inpatient, the average inspection costs and repetitive inspections. Repeat the inspection within 14 days is significantly associated to outpatient, hospital inspection fees and repetitive inspections. 4.According to the medical characteristics, the physician’s seniority is significantly associated to outpatient examination fees. The clinical specialty is associated to outpatient, inpatient examination fees and repetitive inspections. The hospital level is associated to outpatient, inpatient, average examination fees and repetitive inspections. In addition, the hospital ownership shows no significant association in medical resources utilization. Conclusions and Recommendations The study shows the medical cost of repeat CT and MRI examination will increase significantly over time. And patient characteristics and medical characteristics also have significant impacts on medical resource utilization. Its currently controlled use of CT and MRI are important medical orders standby system, specific checks sharing plan, NHI IC card login and upload quality plan and NHI review costs. Because NHI cuts costs will make people change to self-paid. For real suppression fees for medical examination growth, it should establish check rules to use the CT and MRI examination.