年輕型腦中風患者之罹病成本探討

The Costs of Illness on Young Patient with Stroke

王雅婷(Ya-Ting Wang)

指導教授 ： 李亞欣

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2017年)

摘要

根據台灣腦中風醫學會登記的資料顯示，台灣地區腦中風之發生率有年輕化的趨勢，為瞭解年輕型腦中風因罹患腦中風而導致的直接成本、間接成本與罹病成本，本研究以全民健康保險研究資料庫(National Health Insurance Research Database)2011年至2013年百萬抽樣歸人檔，抽樣2012年新發生之年輕型腦中風患者，並觀察其後續之門住診情況至2013年底，重要發現如下：(1)年輕型腦中風比例為男比女2.3:1；年齡越大，發生率越高。北部區域患者約佔此研究樣本的50%；年輕型腦中風患者薪資大多落在三萬塊以內之中低收入，還有11%為收入為0元之眷屬。年輕型腦中風類型比例為梗塞型大於出血型大於其他類型。(2) 此研究中的年輕型腦中風患者住院日數最大為418天，72801~182000元之最高投保薪資群組的住院日數遠遠大於其他四組，有接受手術的患者住院日數沒有比未手術的患者顯著的高但費用有明顯的增高；出血型腦中風的住院日數及住院費用都比梗塞型及其他型來的高。(3)在直接成本中顯示，有接受手術的患者其醫療成本有顯著的提高，出血型腦中風也遠遠高於梗塞型及其他型，接受手術患者與出血性腦中風這兩者之直接成本遠遠高於其他群組，因罹病總成本等於直接成本加上間接成本之總和，本研究結果顯示，其直接成本約佔總罹病成本之三分之二，所以直接成本高，罹病總成本就高。(3)在間接成本的部分顯示住院照顧者費用為主要成本，因住院日數高，住院照顧者費用就高，進而影響間接成本也跟著高。說明了年輕型腦中風患者一旦生病了，家屬因照顧患者而請假或是請看護的費用是一項龐大的支出，當中還未探討無形的照顧者壓力負荷。
根據本研究結果，腦中風對家庭所造成的影響不僅是病人本身，也包括提供長期照護的家屬，建議衛生機關能透過年輕型中風患者之罹病成本估計，提供衛生決策之順序，使有限的資源可以有效利用。

關鍵字

年輕型腦中風 ； 直接成本 ； 間接成本 ； 罹病成本

並列摘要

According to the data compiled by the Taiwan Stroke Association, the incidence of brain stroke in Taiwan has a younger trend. To understand the direct costs, indirect costs and sickness costs of young stroke caused by stroke. This study took the National Health Insurance Research Database, dated from 2011 to 2013, filed data of a millions samplings were sampled which the young stroke patients in 2012 and observed their follow-up doctor clinic situation till the end of 2013. The important founding as the following: (1) the proportion of young stroke patients for male and female is 2.3: 1; the older, the higher incidence rate. Patients in the northern region account for about 50% of the study sample. Most of the young stroke patients earn less than TWD30,000 per month as in the middle to lower income range, and 11% are earn zero as no income dependents. The proportion of young stroke types is infarct type greater than the type of bleeding is greater than other types. (2) In this study, the biggest number of hospitalized days for young stroke patients was 418 days, and the highest insured payroll group of TWD72,801 to TWD182,000 account for greater number of hospitalized days compare to the other four groups. The number of hospital days for patients who had undergone surgery was not significantly higher than that of patients who hadn’t had surgery but the expenses has increased significantly. The number of hospitalizations and hospitalization expenses for Hemorrhagic stroke were higher than infarct type and other types.(3) In the direct cost shows that patients with surgery, the medical costs is significantly increasing, Hemorrhagic stroke is also much higher than the infarct type and other types. The direct cost of both patients undergoing surgery and hemorrhagic stroke is much higher than the other groups. The total cost of the disease is equal to the sum of the direct costs plus the indirect costs. The results of this study show that the direct costs are about two thirds of the total cost of disease, therefore, when the direct cost is high, the total cost of disease is also high. (4) In the part of the indirect cost, the cost of hospital care fee shown as the main cost. Due to the high number of hospital days, the cost of hospital care fee is high, which in turn affects the indirect costs. Indicating that once the young stroke patients are ill, family members who leave work to care the patients or hair a caregiver is a huge expenditure, which has not yet explored the invisible caregiver pressure load.
According to the results of this study, the impact of young stroke on the family is not only the patient themselves, but also including provision of long-term care of the families. It is recommended that health authorities can provide the order of health decisions through the estimated cost of disease among young stroke patients, making the limited resources available for efficient use.

並列關鍵字

young stroke ； direct costs ； indirect costs ； sickness costs

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