Title

死亡前六個月健保醫療費用之地區變異

Translated Titles

Geographic variation in NHI medical spending during the last six months of life.

DOI

10.6833/CJCU.2013.00238

Authors

蔡佳琪

Key Words

地區變異 ; 臨終醫療費用 ; 醫療供給資源 ; Geographic variation ; Cost of dying ; medical resource

PublicationName

長榮大學醫務管理學系(所)學位論文

Volume or Term/Year and Month of Publication

2013年

Academic Degree Category

碩士

Advisor

林文德

Content Language

繁體中文

Chinese Abstract

目的:本研究以台灣360個鄉鎮市區為單位分析各地區平均每人死亡前六個月醫療費用的分佈情形,並探討影響地區間臨終醫療費用變異之相關因素。 方法:本研究資料來源為衛生署2003年死亡資料檔與以ID串檔後之全民健保檔、內政部等統計資料。自變項為地區人口特性(男性人口比、老年人口比、原住民人口比)、都市化程度(都市化市鎮、新興市鎮、高齡化市鎮、偏遠市鎮)、死因資料(死因為癌症之人口比、死於醫療機構人口比、死於本鄉人口比)及醫療供給資源(每千人醫師數、每千人一般病床數、每千人加護病床數),而依變項為各地區平均每人死亡前六個月醫療費用,並以臨終費用指標(End-of-life Expenditure Index,EOL-EI)依校正後臨終費用劃分成五個組別,藉此反映出不同變項與地區臨終醫療費用分佈的情形。最後再以迴歸分析探討影響地區臨終醫療費用變異之相關因素。 結果:校正後地區平均每人死亡前六個月醫療費用為226,931元,變異係數為0.16,而臨終費用最高的地區為台北縣烏來鄉372,958元,最低的地區為台東縣蘭嶼鄉85,044元,相差4.4倍。地區變項為對於地區平均每人死亡前六個月醫療費用之整體解釋力為31.39%(p<0.0001),其中,男性人口比、死因為癌症人口比、死於本鄉人口比、每千人醫師數及每千人加護病床數對於地區平均每人死亡前六個月醫療費用為主要的影響因素。 結論:我國平均每人死亡前六個月醫療費用之地區差異甚大,地區醫療資源、醫療利用型態都會影響地區臨終醫療費用。建議應減少急性醫療服務之利用率,更注重地區資源有效分配,以減少地區間臨終醫療費用之變異。 關鍵字:地區變異、臨終醫療費用、醫療供給資源

English Abstract

Objective: This study employed the 360 townships and cities in Taiwan as units to analyze the regional distribution of average medical expenditure per person 6 months before end-of-life (EOL). Subsequently, relevant factors affecting regional variations in EOL medical expenditures were explored. Method: The data sources for this study included the 2003 death statistics collected by the Taiwan Department of Health, as well as ID-linked data from National Health Insurance and Ministry of the Interior. The independent variables comprised regional demographic characteristics (i.e., population ratio constituted by males, the elderly, and the indigenous), urbanization level (i.e., urbanized, emerging, aging, and remote towns), cause-of-death data (i.e., ratios of deaths from cancer, deaths in a medical institution, and deaths in region of residence), and medical supplies and resources (i.e., ratios of physicians, number of hospital beds, and number of intensive care units per thousand people). Average medical expenditure 6 months before death for each region was established as the dependent variable. After adjusting using the EOL expenditure index (EOL-EI), the expenditures were categorized into five groups. This categorization reflects differing variables and the regional distribution of EOL medical expenditures. Finally, a regression analysis was used to study relevant factors affecting regional variations in EOL medical expenditures. Result: The adjusted average regional medical expenditure per person 6 months before EOL was NT$226,931, and the coefficient of variation was 0.16. Wulai Township of Taipei County exhibited the highest EOL expenditure (NT$372,958), and Lanyu Township of Taitung County had the lowest (NT$85,044). Consequently, the highest regional expenditure was 4.4 times the lowest regional expenditure. The overall explanatory power of the regional variable regarding the average regional EOL expenditure 6 months before death was 31.39% (p < 0.0001). Among the variables, ratios of male population, deaths from cancer, deaths in region of residence, physicians per thousand people, and number of intensive care units per thousand people were the primary factors affecting average regional EOL medical expenditures 6 months before death. Conclusion: Taiwan’s average medical expenditures 6 months before EOL display significant regional variations. Regional medical care resources and medical care utilization modes both affect regional EOL medical expenditures. This study recommends decreasing the utilization rate of urgent care services and further focusing on the effective allocation of regional resources to reduce regional variations in EOL medical expenditures. Keywords: regional variation, end-of-life (EOL) medical expenditure, medical supplies and resources

Topic Category 醫藥衛生 > 醫院管理與醫事行政
健康科學學院 > 醫務管理學系(所)
社會科學 > 管理學
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