台灣醫療用血資源耗用分析之研究

The Study of Blood Resource Utilization in Taiwan

謝佩翰(Pei-Han Shieh)

指導教授 ： 陳錦杏

中臺科技大學/管理學院/健康產業管理研究所/碩士(2011年)

https://doi.org/10.6822/CTUST.2011.00044

摘要

中文摘要
根據台灣血液基金會的統計1994年健保實施前血液供應量為2,626,522單位，而2008年供血量已達5,354,992單位。因此瞭解醫療用血資源耗用的情形與適當性，顯得十分重要。
本研究利用2009年國家衛生研究院，全民健康保險學術研究資料庫之醫事機構基本資料檔、住院醫療費用清單明細檔及醫令清單明細檔進行串檔，以 SAS軟體對各類血品進行描述性統計、t檢定、ANOVA及複迴歸分析影響台灣醫療用血資源耗用因素。
結果顯示2009年的血液血漿共使用4,567,040單位，總費用為2,143,863,262元，每位輸血者平均耗用12.1單位血品，男性平均用血量多於女性；不同性別、年齡、就醫科別與醫院層級、權屬、地區，對不同血品的耗用皆有顯著差異。經迴歸分析發現，年齡、性別、科別及醫院層級為主要影響血液耗用的因素。依輸血準則來檢視，輸注紅血球的同次申報中有11.41%未做相關檢驗，輸注血漿有22.83%未做相關檢驗。
由於影響血品耗用的因素很多，對不同血品的影響亦不相同，應依輸血準則增加用血的適當性。建議健保局應建立申報檢視系統，減少不必要的輸血；醫療機構應加強輸血委員會的功能，提高醫師正確的輸血習慣；血液機構應依不同的地區與醫院特性調整不同的血品生產模式，以提升台灣醫療用血資源耗用之品質。

關鍵字

健保資料庫 ； 醫療血液資源 ； 輸血準則

並列摘要

Abstract
Background: According to the statistics of Taiwan Blood Services Foundation in 1994, the blood supply was 2,626,522 units before the implementation of National Health Insurance. In 2008, the blood supply reached 5,354,992 units. Therefore, it is important to understand the situation and propriety of medical blood consumption. Method: Based on the National Health Insurance’s database in 2009, we collect the data files of medical institute, cost of patients in hospitals and details of care orders. This research shows descriptive statistics, t test, ANOVA and multiple regression analysis on different blood categories by SAS to analysis different factors of medical blood consumption in Taiwan. Results: In 2009, 4,567,040 units of blood were used and total expenditure was NT 2,143,863,262. Each receiver of blood transfusion consumed 12.1 units in average. The average blood consumption of males was higher than females. The consumption of genders, ages, medical departments and hospital levels, authority and regions showed significantly different. Regression analysis finds that age, gender, department and hospital level are the main factors of blood consumption. According to the review of blood transfusion principle, 11.41% red blood cell and 22.83% plasma transfusion of the same report was not tested. Conclusions and Suggestions: There are many factors influence the blood consumption in different categories. Propriety blood consumption should be accord to the blood transfusion principle. It is suggested that Bureau of National Health Insurance should setup the report review system to reinforce the appropriateness of blood consumption. Medical institutes should enhance the function of blood transfusion committee to improve doctors’ right blood transfusion behavior. Blood institutions should adjust different blood production models according to different regions and characteristics of hospitals to increase medical blood resource consumption quality in Taiwan.

並列關鍵字

blood transfusion principle ； medical blood resource ； national health insurance database

參考文獻

王秋華（1986） 。輸血療法。初版。台北市：行政院衛生署。

林東燦（1995）輸血的原則及其併發症。當代醫學，265：13-8。

林媽利（2005）輸血醫學。健康文化事業股份有限公司，149-174。

論文，台北：國立陽明大學 衛生福利研究所。

之探索與醫療資源耗用--以慢性阻塞性肺部疾病患者為例 。醫務管理期刊，9（3），159-173。