急性心肌梗塞之治療價格指數及死亡率變化趨勢研究

The Study on the Trend of Treatment Price Index and Mortality of Acute Myocardial Infarction Disease

郭傑(Chieh Kuo)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2010年)

https://doi.org/10.6833/CJCU.2010.00087

摘要

目的
分析全民健保1996-2006年全國住院及2001-2008年百萬歸人檔資料庫之急性心肌梗塞(AMI, Acute Myocardial Infarction)之治療方式、治療費用及死亡率變化趨勢，並建構急性心肌梗塞之治療價格指數，期能提供全民健保費用調整之政策參考。
方法
利用全民健保全國住院1996-2006年資料庫看住院治療趨勢及2005年之100萬承保歸人檔做為分析之材料，以2001至2008年在醫院申報之住院醫療費用清單檔上主診斷出現AMI（國際疾病分類系統臨床修正版第九版之代碼前三碼為410）之保險對象為研究樣本，並由其住院醫療費用醫令清單檔上之醫令代碼，判斷該次住院之治療方式為冠狀動脈氣球擴張術、支架置放術、心導管血管攝影檢查或內科藥物治療，接著再計算住院開始90天內的住院及門診醫療費用總和。接著利用每年四種治療方式之數量及平均醫療費用，分別計算拉氏物價指數(Laspeyres index)、帕氏物價指數(Paasche index)及費雪理想指數(fisher's ideal index)。最後，利用AMI住院後90天內病人是否回診來估算其死亡率。
結果
1996-2006年健保資料庫全國住院心肌梗塞病人接受心導管氣球擴張術者由1996年591人上升至2006年的5435人，佔所有AMI病人數由1996年11.7%增加至2006年49.2%。1996-2006年冠狀動脈介入性治療佔率明顯上升。AMI之治療費用年平均成長率為4.65%。拉氏CPI指數平均年增率為1.012。帕氏CPI指數計算平均年增率為1.013。費雪理想CPI指數平均年增率為1.012。2005-2008年健保資料庫百萬歸人檔AMI拉氏CPI指數平均年增率為1.058。帕氏CPI指數平均年增率為1.015。費雪理想CPI指數平均年增率為1.037。1996-2006年住院急性心肌梗塞死亡率逐年下降，與衛生署公佈的心肌梗塞死亡率以WHO2000-2025年人口校正後死亡率下降相同。2005-2008年健保資料庫百萬歸人檔心肌梗塞死亡率亦呈現下降趨勢。
結論
1996-2006年健保資料庫全國住院急性心肌梗塞的人數及醫療費用呈現上升的趨勢。治療分項以冠狀動脈氣球擴張術上升的數目及金額最為明顯。1996-2006年全國住院及2005-2008年百萬歸人檔心肌梗塞經濟指數均呈上升走勢。老年人口及女性接受冠狀動脈氣球擴張術的比例增加。心肌梗塞死亡率以全國住院1996-2006年，百萬抽樣2005-2008年及衛生署公佈死亡率皆呈下降走勢。

關鍵字

急性心肌梗塞 ； 冠狀動脈氣球擴張術 ； 冠狀動脈繞道手術

並列摘要

Purpose：Taking advantage of a Central Health Insurance Bureau (NHIB) database about the treatment patterns change of acute myocardial infarction(AMI) since 1996-2006 National Hospital and 2001-2008 million returnees stalls. We differentiated AMI treatment from gender, disease severity, medical costs, hospitalization days and mortality since1996-2008.in hospital and 2005-2008 out-patient databases.
Method：Use of universal insurance nationwide inpatient 1996-2006 database see hospitalization trend and million for 2005 belongs to the insurer who stalls for analysis of materials, 2001-2008 the hospital inpatient medical expenses list appear on the primary diagnosis of AMI. A study of samples, shall be the costs of hospital inpatient medical order list stalls on the hospital order code, determine the internment treatment for coronary balloon angioplasty, stent placement, cardiac catheter examination or medial treatment, then calculate the hospital started within 90 days of inpatient and outpatient medical expenses combined. Then use four treatments of AM about Ithe number and average medical costs, calculation of Laspeyres price, respectively (the Laspeyres index), PAP price (Paasche index) and Fisher ideal index (fisher ideal index). Finally, use AMI hospitalized within 90 days after a patient visits to estimate their mortality.
Result：1996-2006 national health insurance database 591 AMI patients hospitalized received coaronary angioplasty in 1996 and 5435 patients in 2006, the number of patients of all AMI was 11.7% in 1996 and 49.2%.in 2006. Coronary Interventional treatment of accounting rates in 1996-2006. the average annual growth rate of AMI's treatment costs 4.65%. Laspeyres CPI index average annual rate of 1.012. PAP CPI index calculation of the average annual rate of 1.013. Fisher's ideal average annual CPI index 1.012. 2005-2008 national health million samples database of AMI's Laspeyres CPI index average annual rate of 1.058. PAP CPI index average annual rate of 1.015. Fisher's ideal average annual CPI index 1.037. 1996-2006 inpatient acute myocardial infarction mortality dropped and the Health Department announced myocardial infarction mortality to WHO2000-2025 population mortality after calibration. 2005-2008 national health database million samples myocardial infarction mortality has also shown a downward trend.
Conclusion：1996-2006 health insurance database in patient of AMI revealed rising trend of patient’s amount and medical costs. Sub-item’s treatment to AMI of coronary angioplasty increases in the number and amount also. 1996-2006 national hospital and 2005-2008 million samples AMI economic expenditure index upward trend. The older population and women undergo coronary angioplasty were increased gradually. Mortality rate of AMI to the national hospital of 1996-2006, millions of sampling 2005-2008 and the Department of Health announced showed the downward trend.

並列關鍵字

Acute myocardial infarction ； Percutaneous transluminal coronary angioplasty balloon ； Coronary artery bypass surgery

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