糖尿病醫療給付改善方案對糖尿病足患者醫療利用之影響

Abstract

糖尿病足為糖尿病患者常見之併發症，其盛行率在開發中或已開發國家均有上升之趨勢。因此本研究主要目的是探討糖尿病足患者之醫療利用情形和影響因素，以及是否加入糖尿病醫療給付改善方案，對於糖尿病足患者醫療利用之影響。 研究資料來源為全民健康保險資料庫2005~2007年百萬抽樣歸人檔第一組至第二十五組，2005.1~2006.12期間，ICD-9-CM診斷碼為糖尿病且合併有足部潰瘍之糖尿病足患者為研究對象，共641人，其中住診為189人；有加入糖尿病醫療給付改善方案的糖尿病足患者為86人，約占13.4%。 醫療資源利用部分，糖尿病足患者平均每年門急診總醫療費用為41,234.76點，住院總醫療費用為133,334.78點；加入糖尿病醫療給付改善方案患者與未加入之患者相比，其住院次數顯著較低。影響患者醫療資源利用之因素，包含患者的DCSI分數(Diabetes Complications Severity Index)、就醫場所權屬別、就醫場所層級別、就醫場所分局別等。影響糖尿病足患者是否加入糖尿病醫療給付改善方案之因素，以就醫場所權屬別為財團法人、分局別為中區分局者，較傾向加入糖尿病醫療給付改善方案；而分局別為南區分局者較不傾向加入。 多變項分析顯示，病患的DCSI分數、傾向分數、有無重大傷病、就醫場所權屬別、就醫場所層級別、就醫場所分局別、就診醫師性別、就診醫師年齡、就診醫師年資等，與門急診醫療利用有顯著關係；而病患的年齡、DCSI分數、傾向分數、就醫場所層級別、就醫場所分局別、醫師年資等，與住院醫療利用呈顯著關係。 本研究結果發現，加入糖尿病醫療給付改善方案之糖尿病足患者其住院次數顯著較少；而傾向分數越高，即越傾向加入改善方案之病患，其門急診總醫療費用越高、住院總醫療費用越低。建議健保局更積極推動糖尿病醫療給付改善方案，而醫療服務提供者也能落實病患收案。 關鍵字：糖尿病足、傾向分數、糖尿病醫療給付改善方案、醫療利用、全民健康保險

Diabetic foot is a common complication of diabetes. There has been a steady increase in the prevalence of diabetic foot in both developing and developed countries. The purpose of this study was to examine the health services utilization of diabetic foot patients and to analyze the effects of Pay for Performance Program on diabetic foot patients’ health services utilization. The source of the data came from claims data of 100 million sampled registry of groups 1 to 25 from Taiwan National Health Insurance Research Database. The research targets were patients having the diagnoses of diabetes and foot ulcers from 2005 to 2007. Totally 641 outpatients and 189 inpatients were identified from the data. Among them, 86 outpatients participated in the Pay for Performance Program (13.4%). The average outpatient medical expense of diabetic foot was 41,234.76 points on the Relative Value Scale (RVS), and the average inpatient medical expense was 133,334.78 points. The number of inpatient admissions was statistically lower for patients who participated in the Pay for Performance Program than those who did not. Factors associated with patients’ health services utilization were Diabetes Complications Severity Index (DCSI) of patients, ownership of providers, contracted category of providers, and branch bureaus. Patients who received care from hospitals affiliated to medical care corporate and central bureau of National Health Insurance intended participating in the Pay for Performance Program. The multivariate regression analyses results indicate that the outpatient utilization was associated with DCSI, propensity score, catastrophic illness, ownership of providers, contracted category of providers, branch bureaus, doctors’ gender, doctors’ age, and doctors’ years of practice. The inpatient utilization was associated with patients’ age, DCSI, propensity score, contracted category of providers, branch bureaus, and doctors’ years of practice. This study found that diabetic foot patients who participated in the Pay for Performance Program had a significantly lower number of inpatient admissions. Patients with higher propensity score had significantly higher outpatient expenses and lower inpatient expenses. We suggest that the Bureau of National Health Insurance could promote the Pay for Performance Program more actively, and the providers could refer more patients into the program. Keywords: Diabetic Foot, Propensity Score, Pay for Performance Program, Health Services Utilization, National Health Insurance