智能障礙合併糖尿病者就醫之醫療資源耗用情形

The Exploration of Medical Resources Utilization among the Intellectual Disabilities with Diabetes

廖佳慧(LIAO CHIA HUI)

指導教授 ： 徐尚為

亞洲大學/健康學院/健康管理研究所/碩士(2010年)

摘要

本研究旨在探討智能障礙合併糖尿病者醫療資源的耗用情形。採用次集資料分析，利用國衛院2006至2007年之「智能障礙特殊需求檔」進行研究，針對我國智能障礙合併糖尿病者，在門診處方及治療明細檔(CD)中凡符合國際疾病分類碼前三碼250者，並排除就醫次數為一次個案，做為研究對象。採用SPSS 12.0版統計套裝軟體，依照 Anderson第二階段的醫療資源利用擴充模式，針對各相關因素與醫療資源利用情形進行雙變項與複迴歸分析，探討影響門診就醫總費用、門診就醫次數與各變項間是否有達統計上顯著的相關。
研究結果顯示，智能障礙合併糖尿病者平均每人每次就醫之門診醫療總費用為1,416.3元、平均每年每人門診就醫次數為11.69次；另外在分析各項影響因素與醫療資源利用情形的關係也發現：
一、在傾向因素方面：研究對象以女性居多(55.93%)，且平均每年每人就醫之門診就醫次數上高於男性；平均年齡為46.82歲，且隨著年齡的增長，平均每年每人門診就醫次數會降低。
二、在能力因素方面：以投保分局別來看，北區分局的就醫總費用最低，平均每人每年門診就醫次數以東區分局最低；在都市化程度方面，門診就醫總費用似乎隨著都市化程度的降低而減少。
三、在需要因素方面：合併其他慢性病個數越多，其門診總費用越高、平均每年每人門診就醫次數越多。在嚴重程度方面，以重度患者之門診總費用最低。
四、在醫療院所因素方面：門診就醫費用以區域醫院為最高，平均每年每人門診就醫次數以醫學中心為最高。
研究發現，智障合併糖尿病者在大型醫療機構就醫的情形十分普遍。如能讓基層醫療院所發揮基本的醫療照護與預防保健功能，便可減少不必要的醫療資源浪費。建議建立一套完整的篩檢系統，針對高危險群進行追蹤，以減少因糖尿病所引發的後續龐大醫療費用。

關鍵字

智能障礙 ； 糖尿病 ； 醫療資源耗用

並列摘要

This study was aimed at investigating health care utilization of the intellectual disabled with diabetic complications. Subjects were selected from the National Health Insurance reimbursement database of Taiwan, and the Anderson’s Generic Behavior Model of Health was applied to analyze the relevant factors and utilization of medical resources.
This research found that average annually outpatient visit was 11.69, and the expenditure per visit was NT＄1,416.3.
(1)The predisposing component: in addition, we also noticed in analysis of the relationship between the relevant factors and medical resource utilization that female(55.93%) subjects have accounted for a larger portion, who averagely had more treatment times over their male counterparts, that all these subjects, having an average ages of 46.82, were undergoing decreased treatment times as they got older and older.
(2)The enabling component: the northern branch enjoyed lowest total medical cost, while the eastern branch shared a smallest number of treatment times for each subject every year in terms of insurance coverage, and the total cost for outpatient treatments was decreased as the city urbanization developed when it comes to the factor of urbanization.
(3)The need component: the total treatment cost was accumulated to a higher number for each subject on a yearly basis when the subjects suffered from more sorts of complication, while the subjects suffering severe mental retardation diseases conditions witnessed lowest total treatment payouts when the diseases severity was considered.
(4)The factors in medical institutions: the metropolitan hospitals charged a highest ambulatory treatment fees while the academic medical centers provided more treatment opportunities than other hospitals averagely for every patient on a yearly basis.
It has been found in this study that it was extremely common for the mentally disabled patients with diabetic complications to acquire their treatment in large-scale medical institutions. The unnecessary resource waste could be prevented if the grass-roots hospital would provide functions of basic medical care, diseases preventions and healthcare treatment. It is suggested that a complete screening system should be established to track high-risk groups, thus reducing huge follow-up medical expenses cause by diabetes.

並列關鍵字

mental retardation ； intellectual disability ； diabetes mellitus ； medical resource utilization

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