癌症住院病患死亡前使用安寧療護與否之醫療費用的比較分析

A Comparison of Health Care Expenditure of Cancer Terminal Stage Care Between Hospice and Nonhospice Patients

胡楠英(Nan-Ying Hu)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2009年)

摘要

整個醫療體系中瀕死階段是屬於高成本的健康照護，癌症照護是屬於高醫療成本的，癌症為台灣十大死因之首，每年因癌症死亡的人數也逐年增加。本研究旨在探討癌末臨終期病患在最後一次住院時接受安寧療護或傳統照護其醫療費用之差異。
本研究對象為2005年1月1日至2007年12月31日期間，中央健保局住院醫療費用明細檔之系統抽樣中死亡樣本。病患依照護型態分成安寧療護與傳統照護兩組，分別串聯兩組健保住院費用檔與醫令檔，瞭解癌末臨終前醫療利用之現況並比較兩組醫療費用之差異。
研究結果顯示，2005 - 2007年癌症末期住院死亡病患總計2,813人，接受安寧療護共545人，接受傳統照護共2,268人。在控制了病患和醫療機構特質等影響因素後，整體的解釋力達62.6％，癌末病患在臨終期住在安寧病房的天數比傳統病房的天數少，使用安寧療護其醫療費用每人平均花費為NT$37,334，卻比使用傳統照護的醫療費用每人平均少27.1％。
整體而言，安寧療護確實有達到節省成本支出的成效，但是接受安寧療護的癌症末期病患的比率仍偏低。建議政府機關應支持安寧療護的發展，加強醫學教育及民眾教育，讓癌症末期病患在臨終期能接受較合宜的照護方式，且未增加健保醫療費用的支出。

關鍵字

癌症 ； 安寧療護 ； 醫療費用

並列摘要

Objective：The health policy analysis have noted the high cost of the care for the terminal stage patients, and that for the cancer patients is evenhigher. Cancer has become the leading cause of the death in Taiwan since 1982,and cancer deaths have significantly increased in recent years. The purpose of this study is to compare the expenditures of hospice and nonhospice cares of the terminal stage cancer patients.

Methods：The population of the study included all the 2,813 cancerous deaths in Taiwan between January and December, 2005-2007. The data released from the National Health Research Institutes for the inpatient expenditures by admission files were compared .The subjects were divided into twocategories, the hospice and nonhospice medical costs in the terminal stage cancer patients.

Results：Among the 2,813 cancer deaths, 545 of them chose hospice cares which made up 19.4% of the cases. The adjusted relationship between hospitalization costs and the use of hospice care. It can be seen from this analysis that 62.6 %. The study disclosed that the interval
ofhospice stay for the terminal cancer patient is shorter, but the cost
of the stay is cheaper, and is lesser by 27.1%.

Conclusion：We come to the conclusion that the hospice care for the terminal stage cancer patient has cost benefit. However, the acceptance rate is low which makes up only 19.4% of the case. We, therefore, suggest that the governmentally support in this very aspect is essential, as well as the development of hospice care for the terminal stage cancer patients.

並列關鍵字

cancer ； hospice ； expenditures

參考文獻

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