本研究是針對機構式遠距照護進行成本效益分析,研究對象是以加入機構式護理之家遠距照護模式之糖尿病或高血壓病人為主。研究對象於研究期間過世者,則予以排除。機構式護理之家成本部份,以實際投入的人事費、設備費、通訊費、耗材費與租賃費,其中設備費以三年折舊計算。效益部份則以全民健保資料庫,分析加入機構式護理之家遠距照護服務模式前後民眾之健保資源耗用的差異作為效益。 本研究以廣義估計方程式之Two-Part Model分析醫療利用率與醫療費用,並比較加入機構式遠距照護前後醫療費用的差異,作為效益的部份。並以金錢的單位比較機構式護理之家實際投入的成本,以及機構式遠距照護介入後所帶來實質的效益。最後以單維(one-way)敏感效度分析機構式護理之家醫療照護模式之成本效益結果,假設當成本費用固定不動時,預估機構式遠距照護人數使用人數達到多少人時,該機構式護理之家遠距照護模式具成本效益。 在非計劃性醫療方面,居民於加入機構式遠距照護模式前後之就醫機率分別為16.31%與16.95%,加入機構式遠距照護模式前後每人每月平均費用分別為89,196與84,972元,將非計劃性醫療費用與就醫機率相乘後得知,加入機構式遠距照護模式前後之非計劃性醫療費用分別14,547.87與14,402.75元,費用約下降145.12元。機構式遠距照護模式所投入之總成本為2,525,185元,效益為177,626.88元,效益減去成本後得到的總效益值為 -2,347,558.12元。使用單維敏感效度分析後發現,當使用人數達1,451人時所得總效益為 1,644元。 本研究結果顯示,機構式遠距照護於2008年介入後不具成本效益,但當使用人數達到每年1,451人時總效益由負轉為正值。然而,本研究只評估機構式遠距照護介入後一年,加上部份效益尚未納入評估,故機構式遠距照護模式的長期成本效益有待後續追蹤。
This study is to access cost-benefit of telehealth care service in hospitalized nursing homes. The research objects were hypertensive or diabetic patients in hospitalized nursing homes, excluding deceased patients from 2007 to 2008. The cost of telehealth care was composed of personnel, equipment, communication, consumable items and other rental. All equipments were calculated for three-year depreciation. This study compared the difference of medical resources before and after the implant of telehealth care service as benefit by employing National Health Insurance Research Database in Taiwan. We performed two part model of Generalized estimating equation to predict the medical utilizing rate and expenses, and we compare the difference of medical expenses before and after attending telehealth care as benefit. To access the cost benefit of the telecare service, we compared the currency of cost and benefit from hospitalized nursing home care. Finally we applied one-way analysis and assumed that the cost of telehealth services remained unchanged. Also, we would like to predict the number of participants when the benefit was equal or more than the cost. The rate of unplanned medical usage before and after implant are 16.31% and 16.95%, and the unplanned medical fees before and after implant are $89,196 and $84,972. By multiplying the rate of usage with unplanned medical fees, the results were $14,547.87 and $14,402.75 per month. The unplanned medical fees were decreased to $145.12 per month. The total cost of telehealth care was $2,525,185, and the benefit of telehealth care was $177,626.88. The net benefit was $-2,347,558.12 from comparison between cost and benefit. After one-way analyzing, if the participants of telehealth care reach 1,451 then the benefit would be $1,644 more than the cost. The implant of telehealth care in hospitalized nursing home care in 2008 was not cost-benefit. But if the participants of telehealth care get 1,451 then the benefit exceed the cost. However, we only made our research evaluating limit for one year after implanting of the telehealth care service, the long-term cost benefit of telehealth care will still be followed-up afterwards.
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