中風花費之探討

The study of the cost of stroke

郭泰儀(Tai-I Kuo)

指導教授 ： 吳建華

中原大學/理學院/應用數學研究所/碩士(2013年)

https://doi.org/10.6840/cycu201300448

摘要

台灣的全民健保自西元1995年3月起開辦，至2012年6月底止，參加全民健保的總人數共有23,204,518人，納保率已達到99%以上，可以作為重要的研究資源。中風(CVA)在台灣則高居第二大死因，腦中風的復健治療和醫療花費上給予家庭與社會造成極大的負擔和衝擊，且花費逐年增加。在文中使用向行政院衛生署健康資料加值應用協作中心所申請的200萬人抽樣檔資料，從西元2000年至西元2009年為期10年，針對中風花費作探討。

在文中先尋找出新中風個案為實驗組，再用就醫年齡和性別相同以1:1的人數找尋出對照組，除了使用所熟知的一般估計法來對中風花費做評估之外，根據文獻所提出的直接估計法(Direct (Lin) method)來針對中風花費作探討。一般估計法所計算出的實驗組平均花費會比對照組的平均花費來的高出許多，有一部份的原因來自於中風引起之併發症，數據顯示絕大部分的中風的併發症明顯地看出實驗組較對照組人數多出許多，而這些併發症造成了中風患者需要長期至醫院看診，因而造成實驗組的平均花費較對照組高出許多。

直接估計法的精神就在於認為設限的病人花費會比實際的花費來的多一些，針對設限的病人的花費做調整，在文中末端我們針對直接估計法的缺點作探討。

關鍵字

設限 ； 直接估計法 ； 中風 ； Direct (Lin) method ； 平均花費

並列摘要

Total of 23,204,518 people join the National Health Insurance (NHI) from March 1995 to June 2012, NHI has reached more than 99%. It can become an important research resource. Cerebral vascular accident (CVA) is the second highest cause of death in Taiwan. Rehabilitation treatment and medical costs give great burden and impact for family and social. Costs increases every year. The two million sample data is applying to the Collaboration Center of Health Information Application (CCHIA), Department of Health, Executive Yuan. In this thesis, we use the data from the year 2000 to 2009, and we use it to research costs of stroke.

In this thesis, we find out new cases of stroke for the experimental group and then match the same medical age and gender one-on-one for the control group. We estimate stroke costs by generally estimates and direct Lin method. In general, the estimate of the calculated average cost of the experimental group is higher than average cost of the control group. Some reasons caused by complications of stroke. The data show that number of the experimental group more than the control group in most of stroke complications. Patients need long-term to to see the doctor, so average cost of the experimental group higher than the control group.

Censored patients spend costs more than actual costs, so we adjust patients of costs by direct Lin method. Finally, we also discuss the drawback of the direct Lin method.

並列關鍵字

Direct (Lin) method ； censored ； cerebral vascular accident (CVA) ； mean cost

參考文獻

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中文文獻