醫院自主管理對醫療區電腦斷層掃描(CT)醫療利用之影響-以1997~2004年資料為例

The impact of hospital-based budget on the utilization of computed tomography in healthcare regions-1997~2004

鄭婷之(Ting-Chih Cheng)

指導教授 ： 蔡文正 ； 龔佩珍

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

目的：醫療費用上漲是健保開辦以來一直想要控制的問題，而高科技醫療被視為是造成醫療費用上漲的重要因素之一。由國內的資料顯示高科技醫療儀器當中又以電腦斷層掃描使用次數最為頻繁。因此本研究針對電腦斷層掃描之使用情形，深入探討醫院自主管理對電腦斷層掃描醫療利用的影響，並瞭解不同醫院權屬別、層級別和疾病型態電腦斷層掃描使用的狀況。
方法：本研究依據1997-2004年間使用電腦斷層掃描的健保資料進行分析，以衛生署規劃的17個醫療區為觀察單位，分析健保實施後電腦斷層掃描之利用分布情形。應用複迴歸分析，在控制醫療需求面與供給面下，醫院自主管理政策的實施對醫療區電腦斷層掃描門診使用密集度的影響。
結果：研究結果發現1997-2004年間，電腦斷層掃描使用次數逐年增加，在權屬別部份，平均每家公立醫院使用次數使用次數較私立醫院高，但私立醫院使用成長率高於公立醫院；就層級別來看，平均每家醫學中心使用使數最多，但區域醫院的成長率最高；不同疾病型態利用電腦斷層掃描之利用以「腫瘤」、「循環系統疾病」和「損傷及中毒」使用次數是最多，而年平均成長率則以「徵候、症狀及診斷欠明之各種病態」、「精神疾病」最高。在控制其他變項下，一地區之每萬人口醫院醫師數、幼年人口比率、女性人口比率及平均家戶所得，對醫療區電腦斷層掃描使用密集度均有顯著影響，而醫院自主管理的實施對電腦斷層掃描使用密集度也有顯著影響。
結論與建議：電腦斷層掃描的使用多集中於規模較大的醫院和醫療資源較豐富的地區，除了醫院自主管理政策外，醫療需求面和供給面對於電腦斷層掃描使用密集度均有顯著影響。在醫療利用向來由供給面作主導的情形下，相關單位提出的管理政策除了能管控高科技醫療供給面的同時，亦須灌輸民眾正確的就醫觀念和醫療資訊，才能讓醫療資源合理分布以達到使用上的效率。

關鍵字

醫院自主管理 ； 電腦斷層掃描儀 ； 高科技醫療利用

並列摘要

Objective：After National Health Insurance (NHI) was executed in Taiwan, the control of rising healthcare expenditure became an important issue. Many researches have found that high-tech medical instruments are one of the important factors in the rise of healthcare expenditure. According to the domestic data, among the high-tech medical instruments, Computed Tomography (CT) was the most frequent utilized one. Therefore, this study focus on the utilization of CT, and how the hospital-based budget influence the utilization. Also, to analyze the utilization between different authorized hospitals, different level of medical institutes and different disease type of CT utilization.
Method：Using the NHI database from 1997 to 2004 and divided it into seventeen healthcare regions by DOH medical network as the observation units to analyze the distribution of the utilization of computed tomography after the NHI executed. Multiple regression analysis was applied to analyze the influence of hospital-based budget and other related reasons to the utilization of computed tomography.
Result：The result of study found that during 1997-2004, the utilization of CT increased year by year. As to the hospital ownership, the frequency of utilization in public hospitals is higher than private hospitals, but the growth rate in private hospitals is larger than public hospitals. As to the hospital accreditation levels, the utilization of CT in medical center is the most, but the growth rate in region hospitals is the highest. In different disease type, the frequency of ‘Neoplasms’, ‘Diseases of the circulatory system’ and ‘Injury and poisoning’ is the most three ones, and the year growth rate of ‘Symptoms, signs, ill-deffined conditions’ and ‘Mental’is the highest three ones. The numbers of hospital’s physicians, the percentage of women and children population, and the average of household income have significant influence on the average utilization of CT per thousand outpatients. Also, the intervention of hospital-base budget has significant influence.
Conclusions：The utilization of CT is usually centered on large scale hospital or the regions where has more healthcare resource. Besides the hospital-based budget, and the medical demand-side and the medical supplies-side all have the remarkable influence on the utilization of CT. The institutes should not only control and manage the high-tech healthcare supply-side, but also have to teach the right concept of the utilization and information of healthcare to the whole population so that make healthcare resource allocated reasonable to reach the efficiency of using.

並列關鍵字

Hospital-based budget ； Computed tomography ； High-tech medical utilization

參考文獻

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