參與全民健康保險糖尿病醫療給付改善方案之病患其醫療資源利用情形之探討—以某區域醫院為例

An Empirical Study of the Medical Resources Utilization of Diabetic Patients Participitating in the National Health Insurance Diabetes Mellitus Disease Management Program and Advanced Payment Scheme --- Data based on a survey given in a General Hospital

許祐堡(Yu-Pao Hsu)

指導教授 ： 徐學忍

元智大學/管理學院/管理研究所/碩士(2007年)

摘要

糖尿病（Diabetes Mellitus）是一種常見的慢性代謝異常疾病，目前全世界糖尿病人口約有一億三千七百五十萬人，預估西元2010年全球糖尿病人增加率將達到50％，2025年全球糖尿病患人口可達三億。由於現代醫學發達，我國國民生活水準上升、人口結構的改變，使糖尿病成為國人常見的慢性疾病。自1979 年起，糖尿病便居我國十大死因的第五位，而且是十大死因中死亡率上升最快的疾病。由於糖尿病是一種不可逆的疾病，一旦罹患便無法治癒，且常引發各式的併發症，其發生率爲14%至34%，包括視網膜病變、自主神經失調、腎臟病變及心臟血管疾病，因此糖尿病患都需要接受長期的治療照護。基於糖尿病病症的複雜，糖尿病的醫療資源利用（Medical Resources Utilization）也就較其他疾病更為繁瑣，從醫療費用支出層面來看，糖尿病病患較非糖尿病病患的住院率高3 倍，醫療支出為非糖尿病患的5 倍，處理糖尿病併發症費用佔整體治療費用的70％~80％，而且三分之二的醫療費用由老年人產生（ADA，1998）。我國1988年糖尿病的醫療費用支出佔總支出的11.5%，每位病患平均醫療花費是非糖尿病病患的4.3倍（Lin，2001），平均每年需二百零五點六億元來照護糖尿病病患，患有併發症之糖尿病病患的醫療費用佔全部糖尿病醫療費用的85.54%。由於糖尿病盛行率及死亡率逐年增加，以及龐大的醫療費用支出已成為公共衛生及全民健康保險主要課題。
本研究對象之資料來源為2004至2006年北部某區域醫院之「門診處方治療明細資料檔」及「住院總醫療費用清單資料檔」，利用SPSS10.0版軟體分析糖尿病病患參與糖尿病共同照護疾病管理(Diabetes Mellitus Disease Management)其醫療資源利用情形與趨勢，研究結果顯示，參與全民健康保險糖尿病醫療給付改善方案之病患其門診就醫次數、住院天數及住院藥費呈現正成長之趨勢，但在住院次數、門診藥費、門診總醫療費用及住院總醫療費用則呈現負成長的趨勢；病患年齡愈大、有合併症或併發症其個數愈多者，在門診醫療資源利用愈高；病患其第一年之「住院次數」、「住院天數」、「住院醫療費用（不包括藥費）」及「住院醫療費用」較少者，第二年之醫療資源利用亦較少。因此建議衛生主管機關應積極推動醫療院所參與糖尿病共同照護疾病管理，擴大糖尿病照護網，藉由持續性的照護與衛生教育介入，降低病患因為血糖控制不良而誘發的併發症，以提升醫療品質與控制費用。

關鍵字

糖尿病、醫療資源利用 、糖尿病共同照護疾病管理

並列摘要

Diabetes Mellitus (DM) is a commonly seen chronic metabolic disorder. The world population of diabetic patients is about 137,500,000 at present. It is estimated that by the year 2010, the increment rate will reach 50%, and by the year 2025, the total number of patients will reach 3 billion. Due to the advancement of medical science, the improvement of our living standard and the change in the population structure, DM is rather common in our country. Since 1979, DM always ranks the fifth in the top ten causes of death. As it is irreversible and incurable, it always leads to various complications such as retinopathy, neuropathy, renal diseases and cardiovascular diseases. Thus, diabetic patients need long-term treatment and the medical resources utilization is higher than other diseases. In comparison, the admission rate is 3 times higher and the expenditure is 5 times higher. Thus, Diabetes Mellitus disease management is a major issue of both public health and National Health Insurance System.
The data for this study was collected from the database of a northern Taiwan general hospital from 2004 to 2006. Diabetic patients participating in the Diabetes Mellitus Disease Management Program were aimed at the utilization of the medical resources, using the SPSS statistical program to analize the raw data. The result showed that there was an increasing trend over the number of out-patient visits, the duration of hospitalization and the in-patient cost of medication. However, there was a decreasing trend over the number of hospital stay, the out-patient cost of medication and the total expenditure of both the in-patient and out-patient services. Elder patients with more complications utilized more out-patient medical resources. Therefore, we suggested that the authority should urge all of the hospitals to participate in the Diabetes Mellitus Disease Management Program, to intensify the medical care network and to emphasize the patient self-care education, thus to lessen the existence of disease complications due to poor control of blood sugar level and to improve the quality of medical care and subsequently to control the medical expenditure.

並列關鍵字

Diabetes Mellitus, Medical Resources Utilization, Diabetes Mellitus Disease Management

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