以全民健保2004-2005年承保抽樣歸人檔分析 道路交通事故住院患者之醫療利用情形及其相關因素

Abstract

意外事故所造成之死亡高居台灣地區十大死亡因素第五位，其中車禍肇事死亡占意外死亡之首，其所造成的家庭悲劇，社會成本負擔等，影響之深遠。因此本研究擬針對交通事故住院患者所使用之健保醫療利用進行探討。 本研究以承保抽樣歸人檔2004年及2005年之第一組至第四組樣本，抽出住院醫療費用清單明細檔（DD檔）中ICD-9-CM之外因代碼E_code為E810-E829之道路交通事故住院患者，做為本研究之研究對象。合計住院患者1,052人，門診單次就醫11,060人次，門診歸人後為947人。分析結果發現，平均住院醫療費用為38,870.89點，平均單次門診醫療費用為952.40點，歸人後平均每人門診醫療費用為11,123.04點，住院及門診歸人後醫療費用加總，平均每人醫療費用為45,935.16點。 複迴歸分析顯示，性別、年齡、就醫場所特約類別、就醫場所分局別與住院醫療費用對數值有顯著關係，但交通工具與住院醫療費用對數值無顯著相關。另外，性別、年齡、交通工具、就醫場所特約類別、就醫場所分局別則與單次門診醫療費用對數值有顯著關係。門診歸人後，僅年齡與累計總門診費用有顯著相關。住院及門診歸人後加總醫療費用對數值僅和年齡有顯著相關。 後續研究者運用資料庫之餘，可與問卷並行，除了可獲得較完整之相關因素，如是否為酒駕、生活習慣等，亦可估計間接成本，即生產力損失對社會之影響。

Death caused by accidents is the fifth among the top ten leading causes of death in Taiwan, and the traffic accident is the most important one among all the accidents. This situation has made a great influence on the family suffering from the tragedy, and aggravating the social costs. The purpose of this study was to examine the health care utilization of inpatients who suffered from traffic accidents. In this research, the source of data came from panel claims data of the first to the fourth set of sampled registry of beneficiaries of National Health Insurance from 2004 to 2005. E-codes of ICD-9-CM as E810-E829 were selected from inpatient expenditure by admission. A total of 1,052 persons in hospitalization, 11,060 visits in ambulatory visit and sorted into 947 persons were identified in the final analysis. The major results of this research are as follow: The average hospitalizing medical expenses was 38,870.89 points. The average ambulatory care expense per outpatient visit was 952.40 points, 11,123.04 points per person. After aggregating the medical expenses of hospitalization and ambulatory care per person, the average medical expenses per person was 45,935.16 points. Multivariate regression analyses results indicated that hospitalizing medical expenses were associated with gender, age, contract category of providers and place of visits, while it was not associated with type of traffic vehicles. gender, age, traffic vehicles, contract category of providers and place of visits were also significantly associated with ambulatory care expenses per outpatient visit. When looking at ambulatory care expenses per person, total ambulatory care expenses were only significantly related to age after controlling other variables. The aggregation of medical expenses of hospitalization and ambulatory per person were only associated with age. Future researchers could use questionnaire in addition to secondary data analysis. This could not only get more complete relevant factors, such as drunk driving and living habits, but also could estimate the negative socioeconomic impact due to the loss of productivity.