安養機構住民醫療費用耗用之相關因素與就醫特性分析

Features Analysis of Relative Factors Affecting Medical Expenditures in Nursing & Health Institutions

楊淑娟(Shu-Jane Yang)

指導教授 ： 詹前隆

元智大學/資訊學院/資訊管理學系/碩士(2009年)

摘要

台灣慢性病人長期照護一直是全民健康保險及醫療服務上的一大問題，由於醫療技術的進步使得慢性病人的死亡率下降，但因為身體功能的喪失或受限，導致其無法獨立自理生活，長期照護成為家屬及社會醫療資源的沉重負擔，因此慢性病人的後續長期照護問題成了當今政府的重要課題。本研究擷取中央健康保險局北區分局95年1月1日起至97年12月31日共三年，安養機構住民的門診及住診醫療費用申報檔，以95年特約醫事服務機構支援安養機構住民醫療服務上傳至健保局人數計7,007人，以描述性統計分析、卡方統計量（Chi-square）、crosstabs、Pearson相關係數分析、ANOVA、t-test及Linear Regression等方法進行研究。研究結果顯示安養機構住民門診及住診醫療利用情況受就醫屬性、醫院屬性、就醫科別及安養機構型態特性影響。從研究結果也發現，男性住民在門診及住診醫療利用上較女性高，這樣的結果也呈現男性之醫療需求較大，另安養機構類型與醫院層級別有顯著相關性，其醫療費用利用高度成長，明顯安養機構住民之醫療利用及費用確實有較高的現象。為了控制醫療費用之上漲，健保局也因應實施各種不同的支付制度，雖然可以控制費用，但不一定能滿足所有孱弱老人與失能的健康需求。安養機構住民之醫療利用與機構住民之人口特質、疾病及併發症、機構特質、保險制度因素等相關。
另一方面，值得注意的是在安養機構住民門診就醫科別中，復健科有較高之利用與費用，而住診就醫科別以呼吸道疾患尤其明顯，特約醫事服務機構醫師於非報備支援時段前往安養機構進行醫療服務，及安養機構住民前往特約醫事服務機構就醫等醫療費用支出也日益增加，這顯示若要減低醫療費用支出，必須加以控制這三個族群的醫療費用。未來如何規劃安養機構住民就醫可近性與財務醫療穩健平衡，除了需完善規劃長期照護醫療系統及財務平衡外，避免創造醫療需求及控制醫療資源之過度利用，以維持全民健康保險財務穩健與保險制度設計為當務之急。

關鍵字

全民健保 ； 長期照護 ； 醫療資源利用

並列摘要

The long-term care to chronic ill patients has been a crucial problem of national health insurance and medical service. The mortality of has been decreasing due to the progress of medical technology, but the physical malfunction has affected the patient's ability of self care in daily life. Long-term care has become a heavy burden of family and medical resources of society; therefore, it in turn gets to be an important issue for current government administration. This study investigated the expenditure declaration files reserved in Northern Branch of Bureau of National Health Insurance, for outpatient and hospitalization patients from nursing & health institution, dated from Jan.01, 2006 to Dec.31, 2008, the residents of institutions amount to be total 6086 persons. We used a number of measures, such as descriptive statistics analysis, Chi-square, crosstabs, Pearson parameters, ANOVA, t-test and linear regression to analyze the data. Final findings are: the expenditures of outpatient and hospitalization,but a few differences still exist. Also, the degree of healthcare resources utilization by the male is more than the female, it represents that the greater demand for medical care comes from the male than the female, besides, the types of nursing & health institutions have obvious relationships with thelevels of hospitals, hence the medical expenditures greatly increased, apparently their medical employments and expenses do be higher than the average and normal conditions. Attempting to control the increasing of medical expenses, the Bureau of National Health Insurance has been employing various payment systems, though which may control the expenses, but not necessarily it could meet the nursing demands for the wreck old and inabilities of self care. Those medical employments tend to have something to do with the features of population, ills and common diseases, characteristics of institutions, and insurance system.Additionally, it is noticeable that the rehabilitation department has higher medical resources utilization for outpatient, whereas the respiratory tract is higher for hospitalization patient, and the seeking for medical care not within the supportive period. These situations imply that the effectiveness of controlling expenditure can be achieved only by monitoring the three segments of such patients. The measures of how to rationalize the medical resources utilization of residents in nursing & health institutions and the financial balance of the bureau, in addition to the establishment of a fair medical system of long-term, should avoid the abuse and overuse of medical resources, in order to facilitate the functions and advantages of our insurance system and stabilize pertinent financial situations.

並列關鍵字

National Health Insurance ； long-term care ； medical resources utilization

參考文獻

5.行政院衛生署”行政院衛生署衛生統計資訊網.”

12.李怡娟、王潔媛、唐久雯、郭懷婷、尹祚芊（2006）.從機構負責人及專家觀點來探討社區型態安養機構評鑑項目.實證護理，2（3），201-209。

7.邱怡玟、林文元、謝柏均、李家霙、邱瓊慧（2005）.長期照護機構住民營養狀態評估指標之研究.實證護理，1（2），112-122。

18. 鍾明惠、周稚傑2003.”健保居家照護資源耗用者之門診、住院費用之分析.”中華職業醫學雜誌10（1），頁37-42。

13.葉淑惠、林麗味、許耀東、林佩欣、李雪楨（1998）.實施老人長期照護機構教育對老人服務之成果.護理研究，7（2），157-171。