Treatment Cost Analysis of the Cornstarch Explosion Incident - Experience of National Taiwan University Burn Center

八仙塵爆的治療花費分析－臺大醫院燒燙傷中心經驗

張哲瑋(Che-Wei Chang) ； 黃慧夫(Hui-Fu Huang) ； 劉昌杰(Tom-J Liu) ； 柯安達(An-Ta Ko) ； 莊樹揚(Shu-Yang Chuang) ； 吳俞鋒(Yu-Feng Wu) ； 楊永健(Eng-Kean Yeong) ； 戴浩志(Hao-Chih Tai)

《臺灣整形外科醫學會雜誌》 26卷1期 (2017/03) Pp. 99-108

摘要

Background: Cornstarch explosion on June, 27, 2015 at Formosa water park in New Taipei city was a tragic incident resulting in mass burn victims. Those burn patients had similar age, etiology and location of burn injury and were transferred to hospitals all over the island. From the report of the Ministry of Health and Welfare, there were 499 victims with mean burn total body surface area (TBSA) around 40%. The final mortality was low as 3%. All medical expense in this accident was defrayed by government. Aim and Objectives: This study was aimed to assess the detailed cost breakdown among different burn TBSA. Materials and Methods: This was a retrospective study of inpatient burn cost of cornstarch explosion victims treated in NTUH from June, 27, 2015 to September, 30, 2015. The cost data was reported to National Health Insurance (NHI) in unit and was calculated as 1 unit equal to 1 NTD in this study. The breakdown of treatment cost was divided to 15 items NHI reimbursement category. The cost data was stratified to subgroups based on burn TBSA and comparison was undertaken among subgroups. Results: Thirty two patients (23 female, 9 male) were included in this study with mean age 21.5 ± 4.1 years and mean TBSA 42.5± 22.7%. There was no mortality and the mean hospital stay was 66.3 ± 35.9 days. The total inpatient cost was 47,754,039 NTD. The mean cost per patient was 1,492,314 NTD and mean cost per 1% TBSA treated was 35,113 NTD. The main cost of patients who did not require operation was therapeutic treatment fee (38% of total cost). The main cost of patients who required operation would shifted from operation fee to inpatient ward fee as the burn percentage increasing. Conclusion: This catastrophe revealed the true cost expended for acute burn care. This study demonstrates that acute burn care was expensive and may require high expense to deliver a high quality of care. The treatment costs of patients with TBSA＞40% were substantially higher than those of patients with TBSA＜40%. The leading cost among subgroups were also different. Further study will be required to redirect and use the resource more effectively.

關鍵字

burn ； cost ； flame injury ； inpatient expense

並列摘要

背景：2015年6月27日發生在新北市八仙水上樂園的玉米粉爆炸意外造成了大量的燒燙傷病患。這些傷者大多是年輕人，從下肢到上肢及臉被粉塵引發的火焰所灼傷。根據衛福部的統計，此次意外大約有499名傷患，平均的燒燙傷面積占總體表面積（TBSA）約40%。這批傷患經過幾個月的治療，最後的死亡率大約只有3%。此次意外的醫療花費，全部都由政府給付。目的及目標：我們的研究，目的在分析不同燒燙傷面積族群在醫療花費的細項差異。材料及方法：這個回溯性的資料分析，收集了因八仙塵爆在台大醫院住院的病人，於2015年6月27日至2015年9月30號期間所有的住院治療花費。治療花費的的原始資料是以點數作呈現，而在這個研究中，我們以一點當作一塊台幣來做計算。總花費再根據衛福部提供的健保細項做分類。所有病患依據燒燙傷的體表面積分組，再比較各組間的細項差異。結果：一共有32位傷患（23位女性；9位男性）平均年齡為21.5±4.1歲，平均燒燙傷占總體表面積為42.5±22.7%。沒有傷患死亡，平均住院天數為66.3±35.9天。全部加總的住院花費是新台幣47,754,039元。平均每位傷患的花費是新台幣1,492,314元。治療1%總體表面積的平均花費是新台35,113元。對於不須手術的病患，最主要的花費是治療處置費，占38%的總花費。對於需要手術治療的傷患，隨著病患燒燙傷的體表面積增加，主要的花費趨勢會從手術趨向於病房費。結論：這次的災難間接反映出了照顧燒燙傷病患急性期所需要花費。這個研究指出，要提供一個高品質的燒燙傷照護可能要付出相當的話費。燒燙傷面積＞40%以上的花費又比燒燙傷面積＜40%的花費高許多。不同嚴重程度的燒燙傷，主要的花費也不盡相同。如何將有限的資源更有效的分配是值得持續研究的議題。