新罹患癌症病人逛醫院行為之資源耗用探討-以肝癌、結腸直腸癌為例

Shopping Behavior in Healthcare Services of Liver Cancer and Colorectal Cancer Patients

張瑞益(Ruei-Yi Chang)

指導教授 ： 邱尚志

亞洲大學/健康學院/健康管理研究所/碩士(2011年)

摘要

背景與目的
就醫行為理論中有所謂「逛醫院行為」，此行為易引發醫療浪費及不當使用等問題，這在醫療資源日益吃緊的狀況下，益發值得相關單位重視。而癌症病患為醫療資源耗用的高利用族群之一，本研究目的係利用全國性資料之全民健保資料庫 (NHRI)，探討新罹患肝癌與結腸直腸癌病人於本研究期間，其醫療耗用情形與影響逛醫院行為之相關因素，並針對研究結果提出建議。
研究方法
本研究材料為癌症特定主題檔、基本資料檔與承保檔，以2006年癌症主題之承保抽樣歸人檔為主體。癌症分類以ICD-9為依據，肝癌 (ICD-9 Code: 155)與結腸直腸癌 (ICD-9 Code: 153,154)進行篩選，得肝癌44,155人；結腸直腸癌60,814人。經資料處理，得第一次被診斷至第一次接受正規治療之研究期間個案，係本研究對象，新罹患肝癌樣本7,252人；新罹患結腸直腸癌樣本8,535人。以SPSS 12.0套裝軟體，進行描述性、雙變項與邏輯斯迴歸分析，探討新罹患肝癌與結腸直腸癌病人逛醫院行為之影響因素與醫療利用情形。
本研究逛醫院行為定義：新罹癌患者於第一次診斷至第一次接受正規治療期間，前往3家以上(含)不同醫療院所就醫且其主診斷(ICD-9)相同者。
研究結果
新罹患肝癌且有逛醫院行為有243人 (3.4%)，男性為多 (73.3%)；新罹患結腸直腸癌且有逛醫院行為有143人 (1.7%)，女性為多(55.2%)。經卡方分析與獨立樣本T檢定發現，新罹患肝癌以不同程度之年齡層、月投保薪資、都市化程度、CCI分數及罹癌數量與逛醫院行為有關；新罹患結腸直腸癌以不同程度之性別、年齡層、月投保薪資、都市化程度、CCI分數及罹癌數量與逛醫院行為有關，達統計上顯著意義。然影響有無逛醫院行為之因素有：年齡層、月投保薪資、都市化程度、CCI分數與罹癌數量，達統計上顯著意義。
在研究期間比較有無逛醫院行為之醫療資源耗用，新罹患肝癌病人，平均就醫次數亦有四倍差距 (8.3次 vs. 2.1次)；平均期間天數相差約六倍 (124天 vs. 19天)；亦導致此期間每人平均費用比較約有四倍之差異 (25,145點 vs. 6,619點)。新罹患結腸直腸癌病人，平均就醫次數有五倍差距 (11.2次 vs. 2.3次)；平均期間天數相差約六倍之多 (143天 vs. 22天)；相較每人平均費用約為五倍 (49,381點 vs. 9,508點)。
結論
本研究發現影響逛醫院行為的主要因素為：年齡層愈輕、月投保薪資愈高、居住都市化城市低、CCI分數愈高及罹癌數量愈多，則愈易有逛醫院行為傾向。研究亦發現，新罹癌患者的逛醫院行為更會造成醫療花費急速攀升，而此行為應源自就醫次數及期間天數 (Duration)增長，也造成資源浪費或重複使用，病人亦可能延遲就醫，而無法得到最適切的治療。

關鍵字

逛醫院行為 ； 新罹癌患者 ； 醫療資源耗用

並列摘要

The Purpose
The purpose of this study is to explore the relationship between the medical utilization and the behavior of doctor shopping during the duration from the first time diagnosis to the first time regular treatment. This study conducted the National Health Insurance database to analyze the impact factors and medical utilization of doctor shopping in liver cancer and colorectal cancer. The result can provide to policy makers while planning a strategy for the doctor shopping group in order to reduce medical waste.
Method and Material
This was a cross-sectional study by using the secondary database. It conducted the cancer dataset from National Health Research Institutes (NHRI) which included all claim information, registry for contracted medical facilities and registry for beneficiaries in 2006. This study used the SPSS 12.0 software package for the analyses. A p-value of 0.05 was considered to indicate a statistically significant result.
Definition of shopping behavior: The newly diagnosis cancer patient who went to over 3 hospitals for the same chief complain (ICD-9).
Result
There are 243 people got the new liver cancer patients with shopping behavior (3.4%), and mostly are males (73.3%). In the new colorectal cancer patients, 143 has shopping behavior (1.7%), with the majority of female (55.2%). Research showed the new liver cancer patients in different age, monthly insurance income, urbanization, CCI scores, and the numbers of cancer were related to shopping behavior from analysis by chi-square and independent samples T-test. Also the same as in colorectal cancer, it has one more effect which is gander. The determining factors associated with shopping behavior analysis were age, monthly insurance income, utilization, CCI scores, and the numbers of cancer from the logistic regression model.
The study is form the first time diagnosis cancer to the regular treatment period. Compare to the first time diagnosis cancer who was also having treatment among the new liver cancer patients with shopping behavior, the average of visits was four times more (8.3 vs. 2.1), the average of days increased six times more (124 vs. 19), and the medical expenditures was four times more (25,145 vs. 6,619). These were comparing with those who did not have this behavior. The new colorectal cancer patients having shopping behavior, the average of visits was five times more (11.2 vs. 2.3), the average of days increased six times more (143 vs. 22), and the medical expenditures was five times more (49,381 vs. 9,508). These were comparing with those who did not have this behavior. Therefore, the shopping behavior will consume a lot of limited medical resources.
Conclusion
According to the result, we can specify the high risk group which is young cancer patient, high monthly insurance income, the low urbanization level, and having multi-cancers. Those patients may have the doctor shopping behavior and consume more medical utilization.

並列關鍵字

Doctor Shopping Behavior ； Newly Diagnosis Cancer Patient ； Medical Utilization

參考文獻

14. 張苙雲 (1998)。「逛醫師」的邏輯：求醫歷程的分析。臺灣社會學刊，21，59-87。

26. 劉雅文 (2007)：以2005年承保抽樣歸人檔分析高血壓病人之重複醫療資源利用情形。碩士論文，臺灣大學。

20. 黃信勳 (2008)：原發性肝癌病人重複確診之醫療利用情形及其相關因素探討。碩士論文，臺灣大學。

15. 張苙雲, & 謝幸燕 (1994)。就醫流向的長期變遷。中華公共衛生雜誌，13(1)，54-76。

13. 施驊真, 邱亨嘉, 柯成國, 陳昱甫, & 黃于珊 (2005)。旗津地區癌症病患醫療資源使用情形之探討。福爾摩莎醫務管理雜誌，1(1)，9。