中部某醫院慢性呼吸照護病房患者醫療費用及相關因素之研究

Study on Healthcare Expenses and Associated Factors among Patients of Chronic Respiratory Care Wards in a Central Taiwan Hospital

陳姵榛(PEI-ZHEN CHEN)

指導教授 ： 葉德豐

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2020年)

摘要

研究目的：
為提供呼吸器依賴患者完整性的醫療服務，並提升照護品質讓醫療資源可以合理使用，衛生福利部自2000年開始實施「呼吸器依賴患者整合性照護前瞻性支付方式」計畫。
計畫的第三階段-慢性呼吸照護病房，每日支付點數只有第二階段的亞急性呼吸照護病房近一半，然而若發生感染性併發症會影響長期使用呼吸器患者的致死率也會增加診療的費用。本研究藉由分析慢性呼吸照護病房患者之醫療費用探討支付制度合理性，讓醫療機構在照護患者時得到合理的支付點數，以提升照護品質。
研究方法：
本研究擷取中部某區域醫院2016年至 2019年慢性呼吸照護病房健保申報資料，分析慢性呼吸照護病房呼吸器依賴患者醫療資源耗用分布情形及患者特性與醫療資源耗用之關聯性。統計方法包含描述性統計，獨立樣本t檢定(t-test)、單因子變異數分析(one-way ANOVA)及階層線性模型(hierarchical linear modeling)等方法。
研究結果：
階層線性模型分析結果顯示，死亡的患者在每日費用、每日費用差、每日檢查費、每日放射診療費、每日治療處置費、每日特殊材料費及每日藥費均顯著較高；高血壓的患者在每日費用、每日費用差、每日檢查費及每日藥費顯著較低；泌尿道感染的患者在每日費用及每日檢查費顯著較高；累積住院月數短的患者在每日費用差及每日治療處置費有顯著較高；糖尿病的患者在每日檢查費及每日放射診療費顯著較高；洗腎的患者在每日放射診療費顯著較高。
研究結論：
計畫所訂支付點數不足以支付實際醫療費用，應向健保署爭取合理的支付點數。另外，患者死亡前，醫療人員會盡力救治患者，造成當次醫療費用大幅提昇，若可以強化安寧療護之利用可以降低醫療費用，同時也能夠減少患者和家屬負擔。

關鍵字

呼吸器依賴 ； 慢性呼吸照護病房 ； 醫療利用

並列摘要

Research objectives:
To provide ventilator-dependent patients with comprehensive healthcare; enhance the quality of care; and ensure the reasonable use of healthcare resources, the Ministry of Health and Welfare (Taiwan) has implemented the Program of Integrative Care and Prospective Payment System for Ventilator-Dependent Patients since 2000.
In terms of daily cost, the chronic respiratory care ward (RCW) in the third stage of the program requires only half the payment points for subacute RCW in the second stage. However, the occurrence of infectious complications can increase the risk of death in ventilator-dependent patients and thus increase healthcare cost. This study analyzed the healthcare cost for patients in chronic RCWs to determine the reasonableness of the payment system, ensuring healthcare institutions’ receipt of reasonable payment points in return of the services provided and thereby improve their quality of care.
Methods:
After collecting the National Health Insurance claims data for chronic RCWs at a regional hospital in central Taiwan from 2016 to 2019, this study analyzed the distribution of healthcare resource consumption among ventilator-dependent patients in chronic RCWs as well as the correlation between patient characteristics and healthcare resource consumption. The statistical methods used included descriptive statistics, independent-sample t-test, one-way analysis of variance, and hierarchical linear modeling.
Results:
The hierarchical linear modeling showed that deceased patients incurred significantly higher daily cost, daily cost differences, daily laboratory cost, daily radiology cost, daily therapeutic treatment cost, daily special material cost, and daily medication cost than surviving patients did. Patients with hypertension had significantly lower daily cost, daily cost differences, daily laboratory cost, and daily medication cost than those without hypertension did. Patients with urinary tract infection had significantly higher daily cost and daily laboratory cost than those without did; patients with a shorter cumulative length of hospital stay (in months) exhibited significantly higher daily cost and daily therapeutic treatment cost; patients with diabetes incurred significantly higher daily laboratory cost and daily radiology cost than those without did; and patients undergoing hemodialysis had significantly higher radiology cost than those not receiving this treatment did.
Conclusion:
The number of payment points determined by the program was insufficient to pay for the actual healthcare cost incurred; therefore, hospitals should request a reasonable payment system from the National Health Insurance. Additionally, healthcare personnel endeavor to save patients in a critical state, and such a practice can increase healthcare cost considerably. Thus, the use of hospice care can reduce healthcare cost and concurrently alleviate burden on patients and their family.

並列關鍵字

ventilator dependence ； chronic respiratory care ward ； healthcare care utilization

參考文獻

中文部分

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