白內障手術醫療服務利用情形探討—以中部四縣市為例

研究目的：以台灣中部四縣市白內障手術病患，2007年至2008年的門診、住診醫療資源利用為研究分析基礎，進行下列主題研究：瞭解健保局中部轄區四縣市白內障手術件數及醫療利用變化情形。瞭解各層級醫療院所醫療資源利用是否有顯著差異？探討白內障手術併發症發生率偏高之醫院、醫師，醫院層級別、醫師別及影響因素，挑出可能異常之醫院與醫師。研究方法及資料：本研究先以SAS套裝軟體擷取96、97年特約醫事機構申報檔。利用Excel套裝軟體針對96、97年施行白內障手術病人之醫療費用明細檔，進行以描述性統計分析為主：白內障手術年齡群組男、女、件數、佔率；各縣市年齡群組、男、女、件數、佔率；各層級醫師數平均件數；病人歸戶同院所或不同院所執行件數，各層級論量計酬與論病例計酬件數醫療費用點數，論量計酬與論病例計酬平均每件醫療費用點數。研究結果：白內障手術件數與費用均以門診為主，約占96.0%以上，以基層診所實施率最高，地區醫院最低，彰化縣最多，南投縣最少。以成長率來看年齡層21-30歲成長44.44%最高。特材以PMMA Acrylic人工水晶體材質占大部分，使用特殊功能人工水晶體特材遽增，成長469.72%。結論與建議：女性55.87%高於男性44.02%，女性白內障手術較男性多是否因長期在廚房接觸爐火導致？仍待進一步探討。長期於日光下曝曬工作之人或農民是否與文獻所述40歲即可能發生？年輕族群30歲以下很多係先天性，原因為何？環境？高齡產婦？針對特殊功能人工水晶體民眾需自付差額，建議請相關單位評估以提升醫療品質為前題，並減少民眾負擔。

關鍵字

白內障手術；特約醫事機構；論量計酬；論病例計酬

並列摘要

Abstract objective：This research analyzed the utilization of the outpatient and inpatient of cataract surgery from 2007 to 2008, who contact surgery from central four counties of Taiwan. The research objectives include: 1. Realizing the tendency and utilization of cataract surgery from central four counties of Taiwan. 2. Reveal whether there are differences in all level of hospitals. 3. Reveal the factors which have high complication of cataract surgery in all level of hospital as well as on physicians. Methods and Materials：This research use SAS package to analyze 2007, 2008 contact hospitals and physicians claim data. Also, Excel package was used to analyze the cost of cataract surgery. The statistic parameters include: age, gender, cases, counties were analyzed for cataract surgery. Meanwhile, the patients who conduct more than 3 times of cataract surgery were analyze. Fee for service and DRGs cases were been analyzed. Reveal the growth rate for different level of providers. Total medical expenses were analyzed for 2007-2008 cases and the claim code were check for all level of providers. Results：The cataract surgeries were performed mostly by outpatient department at above 96.0%. Among that, clinics performed most of it and the local hospitals were the fewest. 41.0% patients were between 71-80 age years old. The patients increasing rate at 44.44% for age 21-30 years old patients. PMMA intraocular lens consist most of the cataract surgeries. Also, use special function intraocular lens increased 469.72%. Conclusions and suggestions: Female consists 55.87%, and male are 44.02%. Long term cooking in kitchen and near the high temperature stove may contribute to high percentage of female cataract surgeries. The farmer who working under the sun, may cause to earlier carry this disease at the age 40’s. The reason for congenital cataract surgeries under age 30’s still unknown; environment factors could be one of the factors.

並列關鍵字

cataract surgery ； Fee for service ； DRGs case payment

參考文獻

17、Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan Survey Report（2003）.

6. 中央健康保險局：全民健康保險醫療費用審查注意事項（95年1

2. 行政院衛生署國民健康局2007年「中老年身心社會生活狀況長期追蹤調查」

5. 中央健康保險局：全民健康保險醫療費用審查辦法（98年11月

18、Solomon R. Donnenfeld ED. Recent advances and future frontiers in treating age related cataracts JAMA 2003；290：248-5.1

國際替代計量

白內障手術醫療服務利用情形探討—以中部四縣市為例

全文下載

主題瀏覽