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  • 學位論文

不同疾病嚴重度失智症患者居家、日間照護、護理之家服務之成本效性分析

The cost-effectiveness analysis of those who living at home only, day care center and nursing home for patients with dementia among the different disease severity

指導教授 : 葉玲玲
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摘要


我國老年人口至2005 年約佔總人口數9.7%,而失智症盛行率介於1.6% 至6.4%,每7 秒鐘就有1 位罹患失智症。失智症與其他慢性疾病不同,其認知功能退化會造成在職業或社區生活干擾,並出現精神狀況行為,而患者這些行為是造成照顧者主要壓力來源。失智症患者不僅為疾病所苦,也為照顧者帶來精神上壓力,亦替政府及家屬帶來龐大經濟壓力,研究指出失智症全國淨成本為1,283 億元,平均每年每人介於128,349 元至910,685 元,因此澳洲及日本已意識到失智症所帶來嚴重性,開始著重失智症照護之政策,而反觀台灣,於失智症照護政策上鮮少著墨,因此本研究以社會角度來評估不同疾病嚴重度之失智症患者於居家、日間照護、護理之家不同照護方式之經濟成本效性(Cost-Effectiveness)比較分析,並將主要照顧者之照顧時間貨幣化。 本研究直接成本與間接成本則由國衛院健保申報資料及問卷取得資料。以訪談及自填方式收集成本資料及主要照顧者生活品質與負荷資料。研究對象為中部某醫學心、中部某精神專科醫院、以及某區域醫院附設護理之家之失智症患者及其主要照顧者。最後取得有效問卷為143 份,研究結果發現,每人每年使用居家服務平均成本為497,745 元,護理之家服務平均成本為612,254 元,日間照護平均成本為765,572 元。使用護理之家服務之主要照顧者生活品質最好,使用居家服務生活品質最差。若考慮照顧者生活品質,失智症嚴重度為輕度、中度及極重度時,使用護理之家服務最具成本效性;重度時,使用居家服務最具成本效性。若考慮照顧者負荷,失智症嚴重度為輕度、重度及極重度時,使用居家服務最具成 本效性;中度時,使用日間照護服務最具成本效。本研究僅計算主要照顧者時間成本或生產力損失,並無計算非主要照顧者時間成本,因此間接成本會低估。而本研究計算日間照護成本屬於衛政體系,因此日間照護成本無法代表社政體系日間照護成本,且研究對象以中部地區為主,因此研究結果不宜外推至全國。依據結果分析,本研究建議在未來可以更進一步研究不同失智症類型及嚴重度使用不同服務型態之成本效性,讓照顧者了解使用何種服務最具成本效性。

並列摘要


The aged population in Taiwan reached 9.7% of the total population in 2005. The prevalence of Dementia is between 1.6% and 6.4%; with every seven seconds there is a person who was diagnosed with Dementia. Different from other chronic diseases, the impairment of patients’ cognitive function will cause trouble in work, community life and mental disorder; as a result of these behaviors, the caregiver carry a great deal of pressure. Dementia patients not only suffer from the disease but also bring psychological burden for the caregiver and heavy economic load for government and family members. Studies show the national net cost for Dementia is NT$12.83 billion, averaging NT$128,349 to NT$910,685 per capita every year. In Australia and Japan, Dementia Disease has been taken seriously and policies on Dementia patients care are emphasized; while in Taiwan, few policies concerning Dementia patients care have been addressed. Therefore, from social perspective, this study intends to evaluate the economic cost of caring for Dementia patients of different level of illness with different care system, including homecare, daycare and nursing home. We perform comparative analysis for cost-effectiveness and also monetize the care time of main caregiver. Data of direct and indirect costs were obtained from health insurance claims from the National Health Research Institutes and questionnaires. Through interviews and fill-out forms, we collected the information concerning cost of the disease and quality of life and burden carried by the caregiver. Research subjects are Dementia patients and their main caregiver amongst a medical center in central Taiwan, a mental hospital in central Taiwan and a nursing home affiliated with a hospital. Consequently, we collected 143 questionnaires. Research results show the average cost for homecare per capita every year is NT$497,745, NT$612,254 for nursing home and NT$765,572 for daycare. Those caregivers of patients using nursing home have the best quality of life, while as those who using homecare have the worst quality of life. Considering the quality of life of caregiver, it is cost-effectiveness to use nursing home when the Dementia patients are in mild, moderate and extremely major conditions; while in major condition, it is cost-effectiveness to use homecare. Considering the burden of caregiver, it is cost-effectiveness for the caregiver to use homecare when the Dementia patients are in mild, major and extremely major conditions; while in moderate condition, it is cost-effectiveness to use daycare. This study only took into account the time cost and productivity loss of chief caregiver without considering the time cost of non-chief caregiver; hence the indirect cost might be underestimated. The daycare cost discussed in this study belongs to the healthcare system; therefore, it cannot represent the daycare cost in a social aspect. The research subjects locate in central Taiwan; so the research results are not necessarily applicable nationwide. According to the research results, we offered suggestion for future studies to examine cost-effectiveness of Dementia patients with different dementia subtypes and in different service style so that the caregiver can have better understanding which service is more cost-effective.

參考文獻


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被引用紀錄


王欣瑜(2011)。應用聯合分析探討失智症患者家屬對照護屬性之偏好〔碩士論文,亞洲大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0118-1511201215470749

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