台灣支氣管擴張症之健保醫療利用分析

An Analysis of Bronchiectasis-Associated Hospitalization under National Health Insurance in Taiwan

陳添福(Tien-Fu Chen)

指導教授 ： 洪錦墩

中臺科技大學/管理學院/健康產業管理研究所/碩士(2012年)

https://doi.org/10.6822/CTUST.2012.00034

摘要

台灣有關慢性呼吸道疾病醫療利用的探討，大部分著重在阻塞性肺疾病、氣喘及呼吸治療照護等方面，關於支氣管擴張症相關疾病之醫療費用與利用的研究資料，則付之闕如。本研究希望藉由健保資料庫之分析，瞭解支氣管擴張症相關疾病在台灣的發展趨勢，分析支氣管擴張症相關疾病之住院利用與醫療費用，並探討其影響因素。
利用國家衛生研究院「全民健康保險研究資料庫」1998至2008年住院資料進行分析。擷取ICD-9-CM主、次診斷碼前3碼為494之支氣管擴張症患者為研究對象，以病人特性、醫院特性及就醫地點為自變項，依變項為住院醫療費用，分別做單變項、雙變項及多變項之統計分析。
台灣支氣管擴張症相關疾病之住院醫療利用，1998至2008年共有97,912人次，住院率佔總體人口數之39.5/10萬人，其中女性多於男性，65歲以上之住院利用次數最高，平均住院天數為11.13天，平均住院醫療費用為47,797.01元。影響支氣管擴張症相關疾病住院醫療利用之相關因素，包括：性別、年齡、投保薪資金額、合併症嚴重度指標、住院天數、醫院評鑑層級別、醫院權屬別及健保局各分區業務組別。
支氣管擴張症在女性及社經地位較低者有顯著較高比率，須加以關注，提供更多之衛生教育與預防措施，除降低支氣管擴張症罹病率之外，亦可減少其所導致之醫療費用支出。另外，支氣管擴張症隨著年齡越高住院次數也越高，在台灣人口老化比率愈來愈高之時，亦應加強老人之預防保健。

關鍵字

支氣管擴張症 ； 全民健康保險 ； 醫療利用

並列摘要

Background: Domestic research of medical utilization for chronic respiratory diseases mainly focuses on obstructive pulmonary disease, asthma, and respiratory care. Utilization and cost of medical services for bronchiectasis-associated diseases is an issue seldom discussed in previous research. Based on National Health Insurance Research Database, this study attempted to explore the development of bronchiectasis-associated diseases in Taiwan, utilization and cost of bronchiectasis-associated hospitalization, and factors affecting medical utilization.
Methods: From National Health Insurance Research Database maintained by National Health Research Institute, this study extracted hospitalization data of patients diagnosed with bronchiectasis (principal and secondary diagnosis by ICD-9-CM code of 494) during 1998~2008. Using patient characteristic, hospital characteristic, and hospital location as independent variables and cost of hospitalization as a dependent variable, this study conducted univariate analysis, bivariate analysis, and multivariate analysis of the data respectively.
Results: Results indicated that a total of 97,912 persons utilized hospitalization services for bronchiectasis-associated diseases during 1998~2008. The hospitalization rate per 100,000 population was 39.5, and the rate was higher among women than among men. Patients aged above 65 had a higher frequency of hospitalization for bronchiectasis. The average length of hospital stay was 11.13 days, and the average cost of hospitalization was NT$47,797.01. Factors affecting hospitalization for bronchiectasis included gender, age, reported salary of the insured, Charlson Comorbidity Index (CCI) score, length of hospital stay, hospital accreditation status, hospital ownership status, and administrative branch of Bureau of National Health Insurance. Conclusions and Suggestions: It should be noted that the prevalence of bronchiectasis was significantly higher among women and people with lower socio-economic status. Therefore, more health education and preventive measures should be provided to these groups of people to reduce incidence of bronchiectasis and medical expenses required. Besides, frequency of hospitalization for bronchiectasis also increased with age. As the ratio of elderly population is on the increase in Taiwan, more emphasis should be placed on preventive care for the elderly.

並列關鍵字

National Health Insurance ； bronchiectasis ； medical utilization

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