高科技醫療儀器多次使用之相關因素探討-以電腦斷層掃描為例

The factors associated with frequent utilizations of high-tech medical equipment -the case of computed tomography

林佩璉(pei-lien Lin)

指導教授 ： 龔佩珍 ； 蔡文正

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

高科技醫療利用，被視為醫療費用上漲的主要原因之一。根據國內相關研究指出，我國民眾在醫療服務之利用上，普遍存在著跨區、跨級以及重複求醫的問題，因此本研究以最普遍的電腦斷層掃描(CT)為例，藉由分析多次使用電腦斷層掃描之需求者醫療利用情況，進一步探討影響台灣地區電腦斷層掃描多次使用的相關因素。
本研究以1997年至2004年，全民健康保險資料庫西醫門(急)、住診中，在一定觀察時間內多次使用CT者為研究對象，分析其在14天、30天、60天、90天四種觀察期間內之醫療利用情形，並藉由羅吉斯迴歸分析(Logistic Regression analysis)，探討影響民眾多次使用電腦斷層掃描(CT)之相關因素。
研究結果發現，在14天、30天、60天、90天四種觀察期內，男性多次使用CT的機率顯著高於女性，而多次使用CT的年平均成長率則是女性高於男性。在30天、60天、90天三種觀察期間內，隨著年齡的增加，多次使用CT機率隨之增加。在就醫科別部份，以就診次數來看，多次使用CT者的八年平均就診科別以內科次分科最多，年平均成長率以急診醫學科為最高；若以CT多次使用使用密集度來看，則八年平均就診科別以神經外科最多，年平均成長率以復健科為最高。在就醫特性部分，以就醫醫院層級別為醫學中心者及就醫醫院權屬別為財團法人醫院者，多次使用CT的次數最高。而連續兩次因相同疾病型態，重複使用CT最多的疾病型態前三項為「腫瘤」、「循環系統之疾病」、「損傷及中毒」。
此外，本研究發現四種觀察期間內，就醫型態僅為住院者及就醫型態同時包含門(急)、住診者，多次使用CT的機率，顯著高於就醫型態僅為門診者。且當民眾投保地區的每百萬人口電腦斷層儀器數越多時，CT多次使用的機率則顯著越高，但在30天、60天、90天三種觀察期間內，當民眾投保地區每萬人口醫院醫師數越多時，CT多次使用的機率則顯著越低，可能是因為過去研究多針對醫療利用次數進行探討，但本研究是針對多次使用CT的病患進行探討，因此推論當一地區醫院醫師數密度高、醫療資源充足的同時，相對民眾在醫療利用上的選擇較多，跨區就醫或跨院就醫的機率將相對減少，多次使用CT的機率亦隨之降低。而每百萬人口電腦斷層儀器數越多，CT多次使用機率越高，則可能因為操作技術成熟度不足所造成的影像品質不佳，或為了縮短高科技醫療儀器投資成本回收時間，而發生多次使用CT的情形。
依據研究結果，提出以下建議，持續推動管制措施、加強高科技醫療利用事後稽核、提升高科技醫療儀器品質，定期稽查儀器品質。

關鍵字

多次使用 ； 電腦斷層掃描 ； 高科技醫療利用

並列摘要

Objectives: High-tech medical instruments are one of the main factors for the rise of health care cost. According to relevant researches in Taiwan, our residents have some common problems in medical utilizations which are cross-region, cross-hospital accreditation and the frequent utilizations medical. Therefore this study analyzed the frequent user for CT (computed tomography) to explore the associated factors with the frequent utilizations of high-tech medical equipment.
Methods: This study used the sampling dataset which represents all insured patients in Taiwan. This dataset is annually published by National Health Research Institutes. This study employed CT claim data for the years 1997 to 2004. The samples of this study were the patient who had CT services in four observation period by 14days, 30days, 60days, and 90days. This study analyzed the medical utilization of those frequent users of CT. Furthermore the study used the logistic regression analysis to determine the associate factors with frequent utilizations of CT.
Results: The important results of this study are:
(1)Males had higher frequent utilization rate, and females had higher frequent utilization growth rate than males in four kind of observation period.
(2)In three kinds of observation period by 30days, 60days, 90days, the multi-frequent utilization of CT grew with age.
(3)Neurosurgery department had the highest frequent utilization rate of CT. For the annual growth rate of frequent utilization, Rehabilitation department is the highest.
(4)Base on the hospital degree, the patients in medical center had highest frequent utilization growth rate. Base one the hospital ownership, the patients in foundational hospitals had higher frequent utilization rate than private and public hospitals.
(5)On the type of disease, the reason of “neoplasm”, “genitourinary system”, and “injury and poisoning” had higher reiterative utilization rate of CT.
(6)The behavior that patients seek for medical services belonged to only inpatient services, comprehend outpatients and inpatient services had higher frequent utilization rate on CT than patients only with outpatient services.
(7)On the medical behavior, inpatient services and the services comprehend outpatient and inpatient had the higher frequent utilization rate of CT than outpatient services.
(8)CT’s density had a significant influence on CT frequent utilization after controlling for other factors.
(9)In three observation period by 30days, 60days, and 90days, hospital physicians had a significant influence on CT frequent utilization.
Conclusion: When the medicine resources sufficient in a region, the frequency of CT utilization will increase. The reasons for increasing utilization are the needs for the health status, the quality of radiography are unacceptable, or in order to shorten the return time of the investment costs for high-tech medical equipments. According to the results, this study proposes the following recommendations: 1.Confirming the high-tech medical utilization; 2.Monitoring the quality of high-tech medical equipment periodically.

並列關鍵字

frequent utilizations ； computed tomography ； high-tech medical utilization

參考文獻

1.王俊文、王凱淞、張時獻、葉德豐(2003)：高科技醫療儀器利用之探討-以某大學附設醫院加馬刀中心為例。醫務管理期刊，4(4)：1-13。

4.江東亮(2002)：台灣醫療保健支出之趨勢分析。台灣公共衛生雜誌，21(3)：157-163。

5.余秀芳(2003)。台灣地區病人重複住院之分析。國立臺灣大學衛生政策所碩士論文。

7.李隆生(1999)：影響醫院購置昂貴醫療儀器決策之因素--以臺南高雄兩地醫院為例。中華公共衛生雜誌，18(5)：327-33。

27.羅萱(2005)：醫院引進及擴張新醫療科技之影響因素與結果。台灣衛誌，24(5)：385-92。