2001年至2003年台灣五大盛行癌症（肺癌，肝癌，大腸直腸癌，胃癌，女性乳癌）全民健保給付之探究

2001~2003 National Health Insurance (NHI) Reimbursement for Five Prevalent Cancers in Taiwan (Lung Cancer, Liver Cancer, Colorectal Cancer, Gastric Cancer and Women's Breast Cancer)

劉介宇(Chieh-Yu Liu) ； 劉滄梧(Tsang-Wu Liu) ； 劉季鑫(Jih-Shin Liu) ； 蕭金福(Chin-Fu Hsiao) ； 陳立宗(Li-Tzong Chen)

《中華民國癌症醫學會雜誌》 25卷3期 (2009/06) Pp. 195-205

https://doi.org/10.6588/JCOS.2009.25.3.5

摘要

背景：自1995年台灣實施全民健保後，截至目前為止，國內關於癌症治療所使用之全民健保給付之研究，仍然相當缺乏。目前國內相關研究多使用健保資料庫之費用科目進行分析，然而，如此分析無法有效呈現癌症治療成本之特性，有必要進行更深入之分析。本研究主要之研究目的為針對台灣五大盛行癌症（肺癌、肝癌、大腸直腸癌、胃癌、女性乳癌），分析其2001年至2003年之：(1)罹患人數及其趨勢，(2)接受化學治療人數及其趨勢，(3)所申報之健保給付及其趨勢，(4)全民健保癌症治療用藥給付結構（分成化學治療、賀爾蒙治療以及支持性療法）及其趨勢。
資料與方法：本研究採回溯式觀察性研究設計(retrospective observational study design)，研究對象為「全民健康保險研究資料庫」(National Health Insurance Research Database, NHIRD)中之「癌症特定主題專檔」裡2001至2003年度「門診處方及治療明細檔」（簡稱CD檔）中所載主診斷代碼(ICD-9-CM code)為肺癌，肝癌，大腸直腸癌，胃癌，女性乳癌之所有病患，同時透過特殊需求申請，將其他三大承保資料檔一併申請：「門診處方醫令明細檔」（簡稱OO檔）、「住院醫療費用清單明細檔」（簡稱DD檔）以及「住院醫療費用醫令清單明細檔」（簡稱DO檔），並進行串檔分析。統計方法主要使用敘述性統計為主，同時計算其三年內之年增率。此外，本研究使用無母數迴歸(nonparametric regression method)探討歷年接受化療的人數與癌症治療給付之關聯性。
結果：三個年度五大盛行癌症共計約508,981筆（人次）之資料，納入本研究之分析。五大盛行癌症於2001至2003年間，罹患肺癌、肝癌以及胃癌的人數，大致維持一定。然而，大腸直腸癌及乳癌之罹患人數，皆呈現上升的趨勢。其中，尤以女性乳癌罹患人數增加幅度最大，其次為大腸直腸癌。再者，五大盛行癌症接受化學治療之人數，亦大致呈現上升之趨勢，尤以女性乳癌接受化學治療之人數增加幅度最大，其次為大腸直腸癌。在所申報之健保給付（門診與住院）部分，五大盛行癌症皆呈現上升的趨勢，尤以女性乳癌所申報之健保給付增加幅度最大，其次為大腸直腸癌。另外，在女性乳癌的治療上，支持性療法所佔的比率最高（約17%），其次為肝癌（約3%）。五大盛行癌症在總用藥健保支出上皆呈現上升之趨勢，尤其以女性乳癌之用藥健保給付增加幅度較大，其次為大腸直腸癌。最後，在門診與住院成本部分，以平均一位病人一年健保給付來計算，門診健保給付以肺癌與乳癌最高（年平均超過新台幣35,000 元以上）；而住院健保給付方面，亦以平均一位病人一年所需健保給付來計算，以肺癌、大腸直腸癌及胃癌的住院健保給付最高（年平均約新台幣150,000 元以上）。此外，在歷年接受化療的人數是否與每年癌症治療給付的關連性研究部分，每增加一位接受化療之肺癌病患，健保給付約增加新台幣14萬元，大腸直腸癌約為11萬元，乳癌病人約為10萬元。
結論：本研究對於台灣近年來盛行癌症之接受化學治療人數與健保給付之關係、有無接受化學治療人數之歷年趨勢與年增率、以及接受化學治療與支持療法人數之歷年趨勢與年增率提出一個具台灣人口代表性實證研究。研究結果顯示，癌症病患接受化學治療的人數以及所耗用的全民健保成本接逐年增加。面對此一增加的趨勢，不僅對癌症病患及其家屬造成不輕的經濟負擔，也同時會影響全民健康保險資源之配置。

關鍵字

癌症 ； 全民健康保險 ； 全民健康保險給付 ； 用藥給付

並列摘要

Background: Since the inception of the National Health Insurance (NHI) in 1995, studies on NHI reimbursement for cancer treatment have been lacking. Published studies used the cost items from the Bureau of National Health Insurance (BNHI) database, however such cost items do not clearly reflect the real cost structure of cancer treatment, and therefore, further studies are needed. This study was aimed at studying: (1) the incidence trend of prevalent cancers in Taiwan; (2) the trend of cancer patients receiving chemotherapy; (3) the trend of BNHI claimed medical costs of prevalent cancers; (4) the trend and the cost structure of cancer treatments (divided into chemotherapy, hormone therapy and supportive treatment).
Methods: This study adopted a retrospective observational design and the data were retrieved from the National Health Insurance Research Database (NHIRD), which is managed by the National Health Research Institutes (NHRI). This study linked the four main databases of NHIRD: CD, DD, OO and OD, to form a complete cancer research database. This study mainly adopted descriptive statistical methods to display data and time trend. In addition, this study used nonparametric regression to investigate the relationship between annual patient number and NHI reimbursement.
Results: A total of 508,891 records (five prevalent cancers in three years) were eligible. The number of patients with lung cancer, liver cancer and gastric cancer showed remained stable in these three years, however, the number of patients with colorectal cancer and women's breast cancer showed an increasing trend in these three years. Women's breast cancer had the highest annual increase, followed by colorectal cancer. The number of cancer patients receiving chemotherapy also showed an increasing trend for the five cancers. The highest annual increase rate was seen for women's breast cancer, followed by colorectal cancer. The total amount of NHI reimbursement for these five cancers also showed an increasing trend, especially for women's breast cancer, which had the highest annual rate increase. The highest percentage of hormone therapy was for women's breast cancer (17%). The total amount of drug cost also showed an increasing trend for these five cancers, led by women's breast cancer. Lung cancer and breast cancer had the highest average outpatient cost for each patient per year (over NTD$35,000), while lung cancer, colon cancer and gastric cancer had the highest average inpatient cost for each patient per year (over NTD$150,000). Overall, the total outpatient and inpatient costs showed an increasing trend in recent years. Finally, the NHI reimbursement increased to NTD$140,000 for each lung cancer patient, NTD$110,000 for each colon cancer patient and NTD$100,000 for each women's breast cancer patient.
Conclusions: This study of the incidence trend and the cost structure of cancer treatment was highly representative of the Taiwanese population, and it showed a positive correlation between annual cancer patient number and NHI reimbursement and an increasing trend for chemotherapy, hormone therapy and supportive treatment. The results also showed that the number of cancer patients receiving chemotherapy, the total amount of NHI reimbursement and the drug costs had increasing trends in recent years. This increased the financial burden of cancer patients and may alter the allocation of NHI resources.

並列關鍵字

cancer ； National Health Insurance ； NHI reimbursement ； drug reimbursement