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標題: | 總額預算制度對透析病人醫療資源利用之影響 The Impacts of Global Budget on the Medical Utilization of Dialysis Patients in Taiwan |
作者: | Po-Wen Wang 王柏文 |
指導教授: | 薛亞聖 |
關鍵字: | 末期腎臟疾病,透析,醫療利用, end-stage renal disease,dialysis,medical utilization, |
出版年 : | 2005 |
學位: | 碩士 |
摘要: | 摘要
隨著台灣地區醫療與公共衛生的進步及國人平均餘命的延長,慢性疾病取代過去的急性疾病,名列國人十大死因的主要排名,成為國人健康的新威脅。然而慢性疾病當中,腎臟疾病卻常常被人所忽略。醫療科技的進步,末期腎臟疾病病人得以藉由腎臟移植、血液透析及腹膜透析等腎臟替代性療法延續生命。近年來台灣地區接受透析治療的病人人數逐年提高,大幅增加了醫療支出。 為了有效控制醫療費用上漲的壓力,健保局於2001年7月實施西醫基層總額支付制度,並將透析費用獨立設定總額,支付基層診所透析費用。本研究利用全民健康保險資料庫,觀察2000年曾連續申報透析四個月的慢性透析病人,其在基層總額實施前後醫療資源利用情形。 本研究結果如下: 一、基層總額實施後,研究對象透析門診利用次數與費用點數明顯增加。 二、基層總額實施後,研究對象非透析門診利用次數無明顯變化。 三、基層總額實施後,研究對象非透析門診費用點數明顯減少。 四、基層總額實施後,基層診所非透析門診人次數減少,透析門診人次數增加幅度大於其他層級醫療院所。 五、總額實施後,研究對象平均住院次數與住院天數無明顯變化。 綜上所述,本研究建議如下: 一、基層總額實施後,基層診所在透析門診服務提供有衝量的情況產生,應進一步觀察對於透析醫療品質的影響。 二、慢性透析病人以具有生產力的年齡層居多,且有逐年增加的趨勢,建議衛生主管機關應擬定腎臟病防治策略,積極尋找致病機轉,延緩病人進入透析的時間,使其能從事生產,減少醫療支出。 Abstract With the progress of medical and public health, the chronic diseases have replaced the epidemics become the main cause of death in Taiwan. Among the chronic diseases, however, renal diseases are often neglected. With the development of medical technology, patients who have end-stage renal disease(ESRD) could prolong their life by renal replacement therapy such as kidney transplant, hemodialysis and peritoneal dialysis. In Taiwan, the Bureau of National Health Insurance facing the pressure of the growth of dialysis medical expenditure, because the number of dialysis patients increase year by year. In order to control the medical expenditure, the Bureau of National Health Insurance implemented global budget system on physician clinics from July of 2001. The purpose of this study is trying to compare those dialysis medical claims eighteen months before and after the global budget system launching and explore the impacts that system brought on dialysis patients. The results of this study are as follows: 1. After launching the global budget system, the number of dialysis visits and expenditure claims increase significantly. 2. After launching the global budget system, the number of non-dialysis visits does not have obvious change. 3. After launching the global budget system, the non-dialysis medical expenditure claims decrease significantly. 4. After launching the global budget system, although the non-dialysis visits on physician clinics decrease, the dialysis visits on physician clinics increase higher than the other type of medical institutions. 5. After launching the global budget system, the inpatient visits and length of stay of patients with chronic dialysis does not change obviously. In summary, this study is proposed as follows: 1. After launching the global budget system, the physician clinics provide higher dialysis service. Other mechanism should be taken to monitor the global budget system effects on quality of dialysis service. 2. Patients with chronic dialysis are those who have productivity and increasing year by year. It is suggest that in order to reduce dialysis medical expenditure, the Department of Health should take action to prevent renal diseases. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/36010 |
全文授權: | 有償授權 |
顯示於系所單位: | 健康政策與管理研究所 |
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