請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44117完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張睿詒 | |
| dc.contributor.author | Chia-Yen Lin | en |
| dc.contributor.author | 林佳燕 | zh_TW |
| dc.date.accessioned | 2021-06-15T02:40:41Z | - |
| dc.date.available | 2014-09-16 | |
| dc.date.copyright | 2009-09-16 | |
| dc.date.issued | 2009 | |
| dc.date.submitted | 2009-08-11 | |
| dc.identifier.citation | 參考文獻
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44117 | - |
| dc.description.abstract | 研究背景與動機：末期腎衰竭(End-stage renal disease, ESRD)人口逐年快速增加以及龐大醫療費用已成為全世界共同的面臨之問題，而台灣在工業發展化及健康保險普及化的過程，也面臨ESRD病患快速成長與醫療支出高漲的問題。根據USRDS公布數據指出，臺灣的ESRD盛行率及發生率長久以來均位居世界前幾名。目前國內ESRD病患主要依賴維持性透析治療，其中又以血液透析(Hemodialysis, HD)為最大宗；約占九成以上。依照健保支付標準計算，每月支出HD病患之透析治療費用高於腹膜透析(Peritoneal dialysis, PD)病患約四成之費用，因此鼓勵提高PD利用率被視為降低透析費用的當前政策，然而轉換透析模式在透析病患之長期治療過程中也不算少見，而醫療費用是否隨模式轉換而受到影響為值得關注之處。再則，含括透析與非透析等等照護透析病患之整體透析費用情況更非以最初選擇之模式即可二分類表示。因此本研究目的在於探討最初選擇模式時，何種模式才能達到最節省醫療費用之目的；並進一步將轉換模式以及存在世代之影響納入考量。研究方法：本研究利用1997至2007年健保申報資料，並選取連續透析四個月以上之各年新增透析病患為研究對象，最後共計48,565人。觀察個案自透析開始三年內之門診透析、非透析門診、急診與住院醫療費用點數，分別以ITT及As-treated兩種研究設計方法釐清研究問題。結果：PD病患除非透析門診費用外，其餘費用支出皆低於血液透析病患；且HD各年總醫療費用點數約為PD之1.2至1.3倍之間；曾轉換模式之病患醫療費用同樣高於最初PD且未轉換者；但總體而言仍低於HD且未曾轉換者。此外，存在不同世代之新增透析病患明顯具有費用上之差異存在。結論：長期接受PD治療病患之總體醫療費用低於HD；然而節省成本之優勢於現今政策之導向下能維持多久值得深思。為避免轉換模式所帶來更高額醫療費用應該降低不適用PD的病患在最初模式選擇時誤選之比例。 | zh_TW |
| dc.description.abstract | Background: The number of end-stage renal disease (ESRD) enrollees and meical expenditure in the world have increased dramatically. According to the USRDS statistics, the prevalence and incidence of Taiwan is the highest in the world. Several studies report that monthly costs of hemodialysis are higher than peritoneal dialysis with out-patient dialysis expenditure and the hemodialysis use among patient with ESRD in Taiwan is above 90%. According to this, the government wanted to reduce the Nation Health Insurance (NHI) expenditure by enhances the peritoneal dialysis (PD) use. The medical expenditure of caring a dialysis patient is not only dialysis-related but also non-dialysis-related medical services. Is it cheaper in total cost of PD then in HD in Taiwan? There has no answer so far. Objectives: To compare utilization of National Health Insurance (NHI) resources in terms of health expenses, either inpatient or outpatient expenses of dialysis-related and non-dialysis-related, between HD and PD patients. Material and Method: The study examines the impact of initial dialysis modality choice and subsequent modality switches on NHI expenditure in a 3-year period from first time dialysis treatment of each patient.The data was from the NHI claims data. This study also analyzed the influence of different variables, such as gender, age group, and disease severity, to two modalities of dialysis. Result: A total of 48565 incident patient from 1998~2004 were included in the analysis. Average annual total medical expenditure for PD is cheaper than HD, and the dialysis-related expenditure was the major. Compared to “HD, no switch” subgroup, “PD, no switch” had a significantly lower expenditure. Both expenditures of “HD, switch at second year” and “HD, switch at third year” had no difference with “HD, no switch” subgroup. In the contrary, the “PD, switch at first year” had a significantly higher expenditure. Conclusion: Initial modality choice and subsequent modality switches had significant implications for out-patient dialysis-related, out-patient non-dialysis-related, emergency medical service, in-patient-related expenditure on ESRD patients care. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T02:40:41Z (GMT). No. of bitstreams: 1 ntu-98-R96843001-1.pdf: 584688 bytes, checksum: 1ef4b15e4dabdf31640a654e778b392a (MD5) Previous issue date: 2009 | en |
| dc.description.tableofcontents | 致謝 I
中文摘要 II ABSTRACT III 目錄 IV 表目錄 VI 圖目錄 VIII 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 4 第二章 文獻探討 5 第一節 國內外末期腎臟病現況 5 第二節 比較不同透析模式之研究設計探討 13 第三節 不同透析模式病患之模式選擇因素探討 15 第四節 國外透析病患醫療資源耗用相關文獻探討 18 第五節 國內透析病患醫療資源耗用相關文獻探討 24 第六節 國內透析服務現況與全民健康保險 26 第三章 研究方法 29 第一節 研究設計與研究架構 29 第二節 研究假說 32 第三節 研究變項 33 第四節 研究材料與資料處理 35 第五節 統計方法 39 第四章 研究結果 42 第一節 各年新增之長期透析病患特質 42 第二節 最初模式分組之醫療費用點數結果 47 第三節 最初模式與轉換模式分組之醫療費用點數結果 50 第四節 迴歸分析 54 第五節 研究結果小結 61 第五章 討論 62 第一節 研究結果討論 62 第二節 研究限制 75 第六章 結論與建議 76 第一節 結論 76 第二節 建議 77 參考文獻 79 英文部分 79 中文部分 85 附錄 87 | |
| dc.language.iso | zh-TW | |
| dc.subject | 醫療成本 | zh_TW |
| dc.subject | 腹膜透析 | zh_TW |
| dc.subject | 血液透析 | zh_TW |
| dc.subject | modality switch | en |
| dc.subject | medical cost | en |
| dc.subject | Peritoneal dialysis | en |
| dc.subject | intial dialysis modality | en |
| dc.subject | Hemodialysis | en |
| dc.title | 血液透析與腹膜透析病患之長期醫療成本分析 | zh_TW |
| dc.title | Comparison the Hemodialysis and Peritoneal dialysis patients of long-term medical cost and Utilizations. | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 97-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 吳寬墩,蔡淑鈴 | |
| dc.subject.keyword | 血液透析,腹膜透析,醫療成本, | zh_TW |
| dc.subject.keyword | Hemodialysis,Peritoneal dialysis,intial dialysis modality,modality switch,medical cost, | en |
| dc.relation.page | 88 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2009-08-11 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-98-1.pdf 未授權公開取用 | 570.98 kB | Adobe PDF |
系統中的文件，除了特別指名其著作權條款之外，均受到著作權保護，並且保留所有的權利。