醫院特性對醫療資源耗用探討---以住院化學治療為例

Characteristics of Hospital Medical Care Cost --- Inpatient Chemotherapy for Example

李佳玲(Chin-Ling Lee)

指導教授 ： 楊志良

亞洲大學/健康學院/健康管理研究所/碩士(2005年)

摘要

動機:
醫療費用的控制一直是先進國家共同面臨的棘手問題，各種支付方法的使用，不外乎是夠有效的控制醫療費用的成長。而癌症佔據我國十大死因之首己多年，在健保醫療費用中的比率一直很高，其中癌病患入院執行化學治療佔九十年度住院病患個案數比率排名為第四名，因此在費用如何合理的分配是一個重要的課題。然而不同的醫院及不同的管理制度在控制費用的方法上必然有相當的差異，本研究欲瞭解醫院的特性不同對於化學治療的的選擇是否有差異，其影響因素又為如何。

目的:
本研究主要想要探討不同癌症病人，在不同醫院特性其住院化學治療醫療資源之耗用情形，同時找出影響癌症病人化學治療醫療資源耗用的因素。

對象及方法:
研究對象選擇了肺癌、乳癌及結直癌三類癌症的病患，於九十一年度入院執行化學治療的人次，對不同癌症及不同病患及不同醫院特性其醫療資源的耗用情形，進行t-test、ANOVA及廻歸等統計方法。

結論:
本研究結果顯示不同年齡層的癌症病人其醫療資源的耗用有差異，同時發現癌症病人疾病嚴重度高則住院天數增加，相對的醫療資
源的耗用升高，然而在醫院層級別、醫院權屬別、醫院的地區別對醫療費用皆有影響，由研究結果發現醫學中心顯著高於其他層級醫院，在權屬別的影響程度上其影響的結果，則因癌症不同而有不一致的結果，若臨床治療有實證醫學為指引，則醫院屬性不會改變醫師的行為，因此醫療資源耗用一致性較高。

關鍵字

醫院層級別 ； 醫院權屬別 ； 醫院地區別 ； 化學治療

並列摘要

Motive:
Control of medical expense has always been a tough issue faced by developed countries altogether. A variety of payment system set up aims to effectively reduce the increase of medical expense. Cancer has been in the rank of ten major cause of death for several years. Thus, the ratio of medical expense for cancer treatment has been relatively high in the proportion of healthcare medical budget. In particular, according to the list recording the total ratio of individual inpatients, the frequency of cancer inpatients admitted and receiving chemotherapy ranks top four in the year of 90. Hence, proper and reasonable distribution on medical expense is a crucial subject to work on. Nevertheless, different hospitals implement their own management system, which may generate variations on the approaches of medical expense control.

Purpose:
The purpose of this study aims to discuss the condition in terms of how medical resources of chemotherapy are utilized while different cancer inpatients receive treatment from different hospitals with their own hospital characters.

Subjects and Method:
The participants of this study include cancer inpatients of lung cancer, breast cancer, and rectum cancer. The researcher, based on the number of times these cancer inpatients admitted to the hospitals and received chemotherapy, analyze and discuss the utilization of medical resources among various hospitals with different characters. T-test, ANOVA, and multiple regression are used as statistical measures.

Results:
The results show that age of cancer inpatients and degree of illness result into different utilization of medical resources. Provided that cancer inpatients, who suffer from higher degree of illness, stay more days in the hospital, it can cause the increase of such utilization. Moreover, presented from the study, the type, ownership, and regions of the hospitals generate influence on medical treatment expense. In terms of
hospital type, the expense of medical center is apparently higher than that of the hospitals of other type. As for ownership, the expense varies due to different types of cancer disease. However, it is also shown that provided that clinics have evidence-based medical as guidelines, the characters of hospitals would not influence doctor’s behaviors. Hence, under such circumstance, the consistency of medical resource utilization is relatively high.

並列關鍵字

Hospital type ； hospital ownership ； hospital regions ； chemotherapy

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