高尿酸與各類急慢性疾病健保耗用關係探索性之研究

Abstract

台灣健保醫療費用逐年增加，但健保保費收入年成長率低於醫療支出年成長率，導致現行健保制度財務危機逐日惡化；如何維持良好的醫療品質，並兼顧醫療成本的控制及醫療資源的合理分配，已成為健康管理層面重要的課題；如何透過有效的病案及疾病管理，來有效率並公平的分配有限的醫療資源是值得探討的議題。 首先本論文提出一管理會計之疾病管理模式平台，相關步驟為「第一步：找出可治癒之單一疾病」、「第二步：確認此單一疾病與其他慢性病之醫療關係」、「第三步：確認此單一疾病與其他主要急、慢性病之財務（醫療成本耗用）之關係」、「第四步：介入性研究或政策制訂」、「第五步：成果及回饋」，以文獻搜尋分析及統計分析方法之研究方法為主，探討「高尿酸血症與慢性疾病」及「高尿酸血症與急性病」健保醫療成本耗費之關係。主要之結果為，首先在第一步中，找出尿酸是可被治癒的疾病，在慢性疾病部分，主要是代謝症候群、糖尿病、心血管疾病，及腎臟疾病；在急性疾病部分，主要是急性感染及意外事故；在第二步中，藉由國內外文獻搜尋，證實尿酸是與各類急、慢性病之發生、惡化具有意義因果關係；在第三步中，本論文透過文獻搜尋、台灣健保資料庫及百萬歸人檔統計分析，證實台灣尿酸疾病費用之支出與其他急、慢性病具有意義之正相關性，更進一步證實高尿酸與意外事故之產生具有意義之正相關性；在第四步中，本文建議尿酸應納入臨床成人常規性健康檢查項目，並及早治癒高尿酸血症，針對高尿酸血症之患者加強交通安全、意外事故預防之教育；在第五步中，提供學界、醫界及政府單位以本論文所提之管理會計之疾病管理模式平台，尋找其他可控制且可治癒之單一疾病，做有效疾病管理 藉由本論文之結果及討論，我們認為透過成本會計之分析配合臨床疾病之病生理因果關係，是可以有效提升醫療品質、促進健康，同時更妥善控制醫療財務成本。

Taiwan’s National Health Insurance (NIH) expenses are increasing yearly, but the annual growth rate of the premium income is lower than that of medical expenditure. As a result, the NIH is unable to balance its expenses. How to maintain good medical quality, control medical costs and allocate limited medical resources efficiently: These are important issues for health administration in Taiwan. This study use the platform of disease management to achieve these aims. In this study, a unique platform combining accounting management with disease management was created. Our first step was to find a disease that could be cured; the second step was to establish the causal relationship among the target disease, acute diseases, and chronic diseases; the third step was to confirm the financial (medical expenditure) relationship among the target disease, acute diseases and chronic diseases; the fourth step was to propose interventional study and develop administrative policy; and the final fifth step was to solicit feedback and refine the platform. The main results in the study are as follows, step by step: Hyperuricemia was chosen as the curable disease; the chronic diseases were metabolic diseases, diabetic mellitus, cardiovascular diseases and chronic kidney disease; and the acute diseases were acute infectious diseases and accident injuries. For the second step, according to the results of literature review, a positive causal correlation between hyperuricemia and development and deterioration of acute and chronic diseases was established. For the third step, according to the results of literature review and analysis of the Normalized Million People File, National Health Insurance Research Database, a positive correlation was established between the financial relationship for medical expenditure for hyperuricemia and that for acute and chronic diseases; and a positive relationship between hyperuricemia and the occurrence of accidental injury was also established. For the fourth step, we suggested that serum uric acid should be included as an essential item of adult systemic examination in Taiwan, and hyperuricemia should be treated and cured early. Furthermore, subjects with hyperuricemia should receive more education regarding traffic safety and accident prevention. For the fifth step, we suggest that researchers look for other curable single diseases for which they can use our study platform to achieve efficient disease management. In conclusion, based on the integration of analysis of medical costs and analysis of causal relationship of diseases, we can achieve our aims of high-quality medical service, health improvements, and reasonable allocation of medical resources.