以2005年承保抽樣歸人檔分析高血壓病人之重複醫療資源利用情形

Abstract

本研究之目的為分析高血壓病人西醫門急診之重複醫療資源利用情形。研究資料以全民健保資料庫2005年承保抽樣歸人檔第一組至第四組共20萬人為基礎，定義國際疾病分類號第一、二、三欄中(主、次診斷碼)任一欄前三碼為401至405之高血壓病人(共20,209名)為研究對象，分析其重複醫療資源利用情形。 分析結果發現重複使用醫療資源者共8,050名，重複使用率為39.83%，重複用藥率為41.62%，用藥日數重複率為2.75%。重複使用醫療資源者中97.81%有重複用藥，重複用藥者平均每人累計重複用藥13.93天，平均每人累計重複藥費為508.46點。重複使用醫療資源者中19.65%有重複使用非藥品醫令，平均每人累計重複非藥品醫令費用為883.06點。有重複使用醫療資源之高血壓病人，平均每人重複的總醫令費用為670.89點，總醫療費用為3,331.19點。 性別方面，女性重複使用醫療資源之機率較男性高，但男性重複使用醫療資源之程度卻較女性高。年齡方面，年齡愈大者愈容易重複使用醫療資源，重複使用的程度也愈高。有重複使用醫療資源者中，免部分負擔者重複使用醫療資源的程度較需部分負擔者高。 病人之C.C.I.越高，會重複使用醫療資源的機率及程度越高，病人因高血壓而看診之醫師數、醫療機構數越多，重複使用醫療資源的機率及程度也越高。 病人的就醫選擇方面，無固定醫療機構權屬別及特約類別者重複使用醫療資源的機率較低，無固定醫療機構權屬別者重複使用醫療資源的程度也較低。 結論：絕大部分有重複使用醫療資源之高血壓病人有重複用藥。後續研究者可結合問卷，瞭解高血壓病人重複使用醫療資源之原因。

The purpose of the study was to analyze hypertension patients’ overlapped medical utilization by using the 2005 National Health Insurance Registry for Beneficiaries Claims Data files, the medical service utilization data of 200,000 persons. This study identified 20,209 hypertension patients visited western outpatient and emergency department. The percentage of overlapped medical resources utilization, overlapped medication and overlapped days of prescriptions was 39.83%, 41.62% and 2.75%, respectively. Among hypertension patients who used overlapped medical resources, 97.81% also had overlapped medication. The average overlapped days of prescriptions and overlapped medication expenses were 13.93 days and 508.46 points. Nineteen point six percent hypertension patients who used overlapped medical resources also had overlapped non-drug orders. The average overlapped non-drug orders expenses were 883.06 points. The average overlapped total orders expenses of 8,050 hypertension patients who used overlapped medical resources were 670.89 points and the overlapped total medical expenses were 3,331.19 points. Females were more likely to use overlapped medical resources, but the degree was lower than males. Hypertension patients’ medical demand and overlapped medical resources utilization increased as age increased. Once the patients used overlapped medical resources, subjects who did not need to pay copayments had higher degree of overlapped medical resources utilization than their counterpart. The probability and the degree of overlapped medical resources utilization were higher when the Charlson comorbidity index was higher. The more the number of doctors and medical facilities patients visited because of hypertension, the higher the probability and the degree of overlapped medical resources utilization. Subjects who did not have a regular place of care were less likely to overlap medical resources utilization than their counterparts and the degree of overlapped medical resources utilization was lower. Conclusions: The majority of the hypertension patients who had overlapped medical resources utilization also had overlapped medication. Future researchers can incorporate questionnaire to investigate the reasons of overlapped medical resources utilization.