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摘要


背景:本文討論在台灣醫療制度下,頭頸部癌末病人在不同的照護機構所需之醫療成本,分析其醫療成本之組成結構,並探討比較是否安寧照護病房相對於其他的病房,在不影響照護品質的情況下能否降低頭頸癌末的病患的醫療花費。方法:醫療成本涵蓋範圍甚廣,主要由4個部份組成,分別是病房費用、診療費用、藥事服務及處置費用。吾人蒐集自西元2000年8月至2010年12月間,於本院往生或出院後3日內往生之頭頸癌病人,就其住院期間所產生之醫療費用進行分析。結果:共有564名病患被納入本研究,其中男性514名,女性50名。住普通病房者有141名(25.0%),以藥事服務費比重最高,占29.1%,且隨住院時間增加該比例亦增加;安寧病房有293名(51.9%),以病床費比重最高,占26.8%,不管住院時間長短4種醫療費用的比例並無變動;住加護病房有113名(20.0%),以藥事服務費用比重最高,占26.9%,但隨住院時間延長,藥事服務成本比重會逐增;住安養病房者17名(3%),亦以藥事服務費占最高比重,近31%。另外診療費在所有照護機構中所占比重都是最少的。而針對4組病人或家屬所做之住院病人滿意度調查並未呈現統計上的顯著差異。結論:不同照護機構其醫療成本之組成比例亦不相同,考量臨床及經濟等因素,安寧照護具有低醫療支出,並有與加護病房與普通病房之同等效益,況且不隨住院時間長短而增加或變動醫療成本,具有相當的穩定性。因此癌末病人的住院照顧,建議優先考量安寧照護。

並列摘要


BACKGROUND: The purpose of this study is to investigate if hospice care has lower medical expenses without compromising quality than other care settings for end-of-life head and neck cancer (ELHNC) patients.METHODS: From Aug. 2000 to Dec. 2010, a retrospective review was conducted in 564 ELHNC patients who died in our hospital system or died within three days after discharge. These patients were hospitalized in four care settings including hospice, intensive care unit (ICU), general ward (GW), and nursing ward (NW). The medical expenses included four main parts: bed, medical personnel, pharmaceutical, and procedure fee.RESULTS: A total of 564 patients were enrolled in our study, 514 male and 50 female respectively. The highest total and daily expense of care setting was ICU, followed by GW, NW, and hospice. Besides, ICU care also had the highest bed fee, pharmaceutical, medical personnel, and procedure fee, and hospice care had the lowest pharmaceutical and bed fee. Besides, the percentage of pharmaceutical fee was the highest part at GW and NW. There was no significant statistical difference in patient or family satisfaction among these four groups.CONCLUSIONS: Compared with the nonhospice service, hospice care needs the lowest total and daily medical expenses because of its lower pharmaceutical and bed fee. Hence, hospice care is the best way to reduce medical expense and to prevent wasting of medical resources in the health insurance system of Taiwan for ELHNC patients.

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