以全民健保2000–2003年承保抽樣歸人檔分析過敏性鼻炎患者之醫療利用情形及其相關因素

Abstract

過敏被稱為文明病，隨都市發展，人口密集，環境擁擠，其罹病人口與盛行率不論於開發中或已開發國家均有上升趨勢。因國內關於過敏性鼻炎之醫療利用相關研究仍顯缺乏，故本研究擬針對我國過敏性鼻炎患者之醫療服務利用進行探討。 本研究運用全民健保資料庫2000至2003年承保抽樣歸人檔，以疾病分類號出現「過敏性鼻炎及其次分類」者（ICD-9-CM為477、4770、4778、4779）定義為本研究之研究對象，合計門急診56,416人次（14,981人）、住診67人、中醫門診7,735人次（2,403人）。分析結果發現我國過敏性鼻炎盛行率約15％。門急診單次平均醫療費用點數為758.25點；歸人後則為每人每年平均713.86點。影響患者使用醫療利用之因素，年齡在門急診與住診之醫療利用上均扮演相當重要的角色。65歲以上老年人口之醫療費用顯著高於其他年齡組別。此外，有合併或併發症患者、就醫於醫學中心或台北、北區分局轄區範圍之醫療利用較高。 複迴歸分析顯示，門急診單次就醫之性別、年齡、就醫季節、合併氣喘、就醫醫事機構權屬別、特約類別、就醫地區健保分局別、就醫科別與門急診醫療利用對數值均呈顯著相關。出生季節與藥費、給藥日份、診療明細金額等對數值有顯著相關。門急診歸人之性別、年齡則與門急診醫療利用對數值均有顯著相關。羅吉斯迴歸顯示住診患者之年齡與醫療利用對數值有顯著相關。由本研究之結果，吾人建議衛生主管機關考慮將過敏性鼻炎納入論質計酬相關方案，加強完整、連續性照護。醫療服務提供者應多注意是否患者有過敏性鼻炎而不自知，避免病患未及時尋求醫療而導致併發症。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，如家族病史、成長環境等，亦可估計間接成本，即生產力損失對社會之影響。

Allergic rhinitis is one of the most common chronic allergic diseases. The prevalence rate of allergic rhinitis is increasing in developed and developing countries, as a result of the development of city, the crowded population and environment. The purpose of this study was to examine the health care utilization and related factors of allergic rhinitis patients. The source of material came from claims data of the first and second set of sampled registry of beneficiaries of National Health Insurance from 2000 to 2003. ICD-9-CM with four codes as 477, 4770, 4778, or 4779 were selected from the panel database. A total of 56,416 visits (14,981 persons) in ambulatory care and emergency, 67 persons in hospitalization, and 7,735 visits (2,403 persons) in chinese medicine were identified in the final analysis. The major results of this research are as follow: The prevalence rate of allergic rhinitis in Taiwan is about 15％. Samples were mostly among those age 5 to 12 years, 21 to 34 years and 35 to 49 years. The average medical expenses per outpatient visit was 758.25 points, 713.86 points per person per year. Patients among 0 to 4 years had higher outpatient visits, but patients over 65 years of age had the highest direct expenditure. Factors related to higher medical expenditure were patients with comobidities or complications, received care from medical centers, from Taipei branch or Northern region branch of the Bureau of National Health Insurance. Multiple regression results indicate that all kinds of ambulatory and emergency care expenses per outpatient visit for western medicine were significantly related to gender, age, season of visiting, with comobidity of asthma, ownership of the provider, contract category of providers, place of visits and department of visits. The amount of drug, days of prescription and the amount of treatment were significantly related to season of birth. All kinds of ambulatory and emergency care expenses per person for western medicine were significantly related to gender and age. Logistic regression indicate that the expenses of hospitalization were significantly related to age. From results of this research, we suggest that the health authorities could consider to include allergic rhinitis in the pay-by-performance program, emphasize the completeness and continuity of care. The health care provider could pay more attention to the patient who didn’t know that they have the disease, thus delayed seeking medical care. Future researchers could use questionnaire in addition to secondary data analysis. This not only could get more complete relevant factors (i.e. family disease history, the growth environment）, but also could estimate the negative socioeconomic impact due to the loss of productivity.