影響職業傷害住院病患醫療費用因素探討

Factors of Medical Cost among Occupational Injury Inpatients

趙子雲(Tzu-Yun Chao)；黃茹筠(Ju-Yun Huang)；鍾其祥(Chi-Hsiang Chung)；簡戊鑑(Wu-Chien Chien)

醫療費用 ； 職業傷害 ； 健保資料庫 ； Medical cost ； Occupational injury ； National health insurance research database

勞工安全衛生研究季刊

21卷4期（2013 / 12 / 01）

404 - 431

繁體中文;英文

目的：描述職業傷害住院患者各項流行病學特性，並找出影響醫療費用之因素。方法：本研究以2009年健保「住院醫療費用清單明細檔（DD）」串連「醫事機構基本資料檔（HOSB）」及承保資料檔（ID），以國際疾病分類代號（ICD-9-CM），選取15歲以上之「職業災害」個案，以SPSS 19.0分析。結果：2009年職業傷害住院計有20,719人次，男性佔多數（73.0%），年齡以25～44歲為主（52.4％）；就醫層級以區域醫院比例最高（46.1%）；就醫科別以骨科最高（53.7%）。傷害類型以上肢及下肢骨折比例最高，分別為17.4%及15.4%；傷害原因以機動車事故比例最高（37.7%）；平均住院天數為8.02天；平均醫療費用NT$52,126；住院死亡佔0.3%。影響職業傷害住院醫療費用的因素有性別、年齡、保險類別、傷害類型、傷害原因、重複住院、就醫地區別、都市化程度、就醫層級、就醫科別、住院天數、手術、治療處置及住院死亡。結論：本研究發現職業傷害病患各項流行病學特徵與醫療費用之分布，並找出醫療費用影響因素，其中，住院天數及手術對醫療費用上升影響最大。

Objectives: To describe epidemiological characteristics and to find the associated factors of medical cost among occupational injury inpatients. Methods: This research brought ”inpatient expenditures by admissions (DD)”, ”registry for contracted medical facilities (HOSB)”, and ”registry for beneficiaries (ID)” from National Health Insurance Research Database in 2009 into analysis by using SPSS 19.0 software. We selected ”occupational injury” samples according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) with aged 15 and over. Results: There were 20,719 events of occupational injuries inpatients. Males exhibited higher proportion (73.0%), and aged 25-44 occupied the most (52.4%). The proportions of inpatients were highest in regional hospital (46.1%) and the department of orthopedics (53.7%) separately. The dominant injury types were upper and lower limb fractures (17.4% and 15.4%, respectively), and the common causes were motor vehicle injuries (37.7%). The average of length of days was 8.02, and the average of medical cost was NT$ 52,126. Inpatient mortality accounted for 0.3%. The factors associated with medical costs caused by occupational injury inpatients were gender, age, insurance type, injury type, cause of injury, repeated hospitalization, geographic region, degree of urbanization, hospital level, departments of hospital, length of days, surgical operation, treatment, and inpatient mortality. Conclusions: The study found epidemiological characteristics, distribution of medical cost, and the associated factors of medical cost among occupational injury patients. Among the associated factors, length of day and surgical operation had dominant impact on increase of medical cost.

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