疾病複雜度與跨區住院比例之分析

The Analysis of Complexity of Disease and the Proportion of Cross-Region Admission

黃家慧(Huang Jia-Huey)

指導教授 ： 楊志良 ； 洪維河

亞洲大學/健康學院/健康管理研究所/碩士(2004年)

摘要

醫療網計畫的目的在均衡各區域的醫療資源發展，建立區域性的醫療網及醫療分級制度，其中分級醫療的政策規劃區域內的醫療單位依其功能分別擔負初級、二級和三級醫療的任務，期使民眾依病情的需要選擇合適的醫療院所就醫。本研究旨在檢視臺灣分級醫療的政策成效，以醫療次區域為分析單位，二級與三級住診醫療服務的跨區就醫比例為指標，並採用複迴歸分析技術探討疾病複雜度的跨區住院比例與其影響因素之關係。
　　本研究採用2000年衛生署「健保住院申報檔案」資料，選取肺炎、消化性潰瘍、闌尾切除術、骨折等為適合在二級醫療機構（地區醫院）處理的疾病類別，及惡性腫瘤、急性腦血管疾病、心導管等為適合在三級醫療機構（準區域醫院以上層級）處理的疾病。研究結果發現：
1.2000年台灣醫療次區域跨區住院比例，二級疾病為57.3%+-27.3%，三級疾病為71.8%+-23.8%。亦即，疾病複雜度增加時，則有較高比例的跨區醫療利用情形。
2.都巿化程度、巿場競爭程度與急性病床供給的增加，及設置較高層級的醫療機構等，均能有效減少民眾跨區住院的情況。
3.區域內的醫療機構層級對跨區住院比例有顯著影響，次區域擁有區域醫院比沒有區域醫院可顯著減少二級疾病跨區住院比例，次區域擁有醫學中心比有區域醫院可顯著減少更多的三級疾病跨區住院比例。
根據研究結果，建議衛生主管機關應加強輔導地區級醫院，提升醫療品質，使其發揮應有之功能，並落實雙向轉診機制。並建議後續研究者根據DRGs病例分類系統建構照護層級，作更深入的探討。

關鍵字

跨區就醫 ； 分級醫療 ； 疾病複雜度

並列摘要

The objective of the Medical Care Network Project was to balance the development of medical resources in all regions by setting up regional medical network and hierarchy of medical services. The policy of hierarchical medical care differentiates the roles of different levels of hospitals so that patients can receive appropriate medical treatment. This study aims to examine the effect of the hierarchical medical care policy. We treat the medical care sub-regions as our unit of analysis. Hierarchical multiple regression models were employed to examine the correlation between determinants that including complexity of disease and the proportion of cross-region admission.
　　This study was based on the nationwide inpatient information in 2000, provided by the Department of Health. Diseases of secondary care include Pneumonia, Appendectomy, Peptic Ulcer, and Bone Fracture, which can be treated by community hospitals. Diseases of tertiary care include Cancer, Cerebral Vascular Accident (CVA), and Cardiac Catheterization, which should be treated in regional hospitals or hospitals of higher level. The major findings of this study are as follows:
1.In Taiwan, for the year 2000, the proportion of cross-region admission for secondary care is 57.3%+-27.3% in medical care sub-regions, the proportion of cross-region admission for tertiary care is 71.8%+-23.8%.
2.The medical care sub-regions which are more urbanized, more competitive, and having more intensive care units, were evidently lower proportion of cross-region admission.
3.Results from multiple regression analyses show that having hospitals of higher levels will lower the proportion of cross-region admission.
　　Based on results of this study, we suggest that we need to improve medical care quality of small community hospitals and establish a workable referral system.

並列關鍵字

Cross-Region Admission ； Hierarchical Medical Care System ； Complexity of Disease

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