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  1. NTU Theses and Dissertations Repository
  2. 公共衛生學院
  3. 健康政策與管理研究所
請用此 Handle URI 來引用此文件: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/45916
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dc.contributor.advisor楊銘欽(Ming-Chin Yang)
dc.contributor.authorChih-Chi Changen
dc.contributor.author張芝綺zh_TW
dc.date.accessioned2021-06-15T04:48:47Z-
dc.date.available2015-09-13
dc.date.copyright2010-09-13
dc.date.issued2010
dc.date.submitted2010-08-03
dc.identifier.citation中文部分
中央健康保險局. (2009). 建構整合式照護模式並逐步朝促進醫療體系整合計畫. from http://www.nhi.gov.tw/
中央健康保險局. (2010年5月引用). http://www.nhi.gov.tw/webdata/AttachFiles/Attach_13240_2_164次總額季報表26-27.pdf.
行政院主計處社會指標統計. (2010年五月引用).
行政院衛生署. (2001). 中華民國八十九年衛生統計.
吳淑瓊, 梁浙西, & 林惠生. (1993). 老人長期照護研究.
林惜燕. (2005). 慢性病老年病人門診潛在性不適當用藥與不良結果之關係. 國立台灣大學醫療機構管理研究所碩士論文.
梁煙純. (2004). 我國多重慢性病患盛行率及醫療利用分析. 國立陽明大學醫務管理研究所碩士論文.
陳惠姿. (2007). 整合性照顧系統. 護理雜誌, 54(5), 5-10.
紀姵嘉. (2009). 糖尿病患使用中、西醫門診之模式對醫療資源利用的影響. 國立台灣大學醫療機構管理研究所碩士論文.
劉雅文.(2008). 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.國立台灣大學醫療機構管理研究所碩士論文.
英文部分
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? . J Health Soc Behav 36, 1-10.
Anderson, G. (2003). public and policymaker perspectives on chronic conditions. . Arch Intern Med, 163, 437-442.
Anderson, G., & Horvath, J. (2004). The Growing Burden of Chronic Disease in America. Public Health Reports, 119, 263-270.
Anderson, G. F. (2005). Medicare and Chronic Conditions. The new england journal of medicine, 353, 305-309.
Hoffman, C., Rice, D., & Sung, H. Y. (1996). Persons with chronic conditions: theirprevalence and costs. JAMA, 276, 1473-1479.
Hwang, W., Weller, W., Ireys, H., & Anderson, G. (2001). Out-of-packet medical spending for care of chronic conditions. Health Aff, 20, 267-278.
Lee, T. A., Shields, A. E., Vogeli, C., Gibson, T. B., Min, W.-S., Marder, W. D., et al. (2007). Mortality Rate in Veterans with Multiple Chronic Conditions. J Gen Intern Med 22(3), 403–407.
Michael, F. D., Bernie, J. O., & Brien, G., L. (Eds.). (1997). Methods for the economic evaluation of health care programmes. New YorkO: xford University Press.
Mollica, R. L., & Gillespie, J. (2003). Care Coordination for People with Chronic Conditions. Portland, ME: John Hopkins University.
Partnership for Solutions (cited March 2010).
Walker, A. E. (2007). A Multiple chronic diseases and quality of life: patterns emerging from a large. . Chronic Illn, 3, 202-218
Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med, 162, 2269-2276.
Wu , S., & Green, A. (2000). Projection of chronic illness prevalence and cost inflation.
dc.identifier.urihttp://tdr.lib.ntu.edu.tw/jspui/handle/123456789/45916-
dc.description.abstract研究背景與目的:國內外研究皆顯示,慢性病盛行率逐年上升,多重慢性病患乃是我國醫療照護系統中最重要的資源使用者,且隨著我國人口結構的逐年老化,多重慢性病的盛行率將逐年升高,其醫療照護課題也將愈趨重要,本研究目的主要是在了解65歲以上慢性病患基本特質與其重複醫療利用情形,並探討整合式照護模式對其可能產生之影響。
研究方法:研究資料採用國家衛生研究院所提供的全民健康保險學術研究資料庫2006-2007年百萬承保抽樣歸人檔,研究樣本最後選取之所有慢性病患共73,027人,其中忠誠病患共41,957人,。以t檢定、變異數分析(ANOVA)及卡方檢定作檢定,並採用對數複迴歸及逐步複迴歸統計方法探討慢性病患者之醫療資源利用情形與其影響因素。
研究結果:根據本研究之定義,忠誠病患同院多科就診者占60.5%,有重複用藥者占67.2%。醫療費用上,忠誠病患平均每人每年重複診查費為1,037.90點;所有慢性病患平均每人每年重複診查費為2,102.50點,平均每人每年重複藥費為16068.06點,平均每人重複用藥日數為28.42日。女性慢性病患在對同一家機構的忠誠度上比男性要高,在總藥品項數上以女性較高,總重複用藥費用上以男性較高。除85歲以上者可避免多次就醫診察費隨著年齡的增加而上升,總用藥項數也隨年齡之增加而上升。隨慢性病數、看診醫師數、就醫科數之增加,越容易重複醫療利用,也越容易忠誠於一家機構,可避免多次就醫之診察費、總藥品項數、總重複用藥費用以及總重複用藥日數皆隨著慢性病數之增加而上升,但在所有慢性病患中,隨著機構數的增加,越不容易重複用藥,且總重複用藥費用及總重複用藥日數是越低的。
研究結論:研究發現隨年齡、慢性病數、就醫科數及看診醫師數之增加,重複醫療利用之情形會越來越高。
zh_TW
dc.description.abstractBackground and objectives: Studies have shown that the prevalence of chronic diseases increased year by year, and patients with multiple chronic diseases are the most important users of our health care system. As the population aging, the prevalence of multiple chronic diseases will increase and the issue of their medical care will be more important. The purpose of this study was to understand the basic characteristics of patients 65 years old and over with chronic conditions and the potential effects of integrated care program on their medical utilization.
Methods: The source of data came from claims data of the first to twenty-fifth sets of samples registry of beneficiaries of National Health Insurance of 2006 and 2007. Study sample of patients were 73,027 people of all chronic patients and, among them, 41,957 people who were loyal to a medical institution . Data were analyzed by using student’s t test, analysis of variance (ANOVA) and chi-square test. Multiple logistic regression and stepwise multiple regression were used to explore utilization and factors of patients with chronic conditions.
Results: According to the definition of this research, among all the study samples, 60.5% were loyal patients who had multiple specialty visits in a medical institution, and 79.5% had overlapped drug use. On the medical expenses, the loyal patients’ average annual overlapped diagnosis fees were 1,037.90 points; and all chronic patients’ average annual overlapped diagnosis fees were 2,102.50 points, their overlapped drug cost were 13713.26 points and the overlapped drug use days per person was 35.77 days. Women had a higher percentage of loyalty to a medical institution and they also had higher total number of drug items, but the total cost of overlapped drug use was higher in male. In addition to the patients who were older than 85 years old, the avoided multiple medical diagnosis fees increased with age, and the total drugs increased with age,too. Patients with higher number of chronic conditions, the number of physician visits, and the number of medical specialists, were more likely to have multiple specialty medical treatment and overlapped drug use, and the probability of the loyalty to a medical institution was higher. The avoided diagnosis fees, the total number of drug items, the total overlapped drug costs and the total number of overlapped drug use days all increased with the increase of chronic conditions. But in all chronic patients, with the number of medical institutions increase, the probability of the overlapped drug use decreased, and the total cost of overlapped drug use and total number of overlapped drug use days were also decreased.
Conclusions: The study found that, the overlapped medical utilization increased as age, number of chronic conditions and number of the physicians visit increased.
en
dc.description.provenanceMade available in DSpace on 2021-06-15T04:48:47Z (GMT). No. of bitstreams: 1
ntu-99-R97843014-1.pdf: 762393 bytes, checksum: 73d83247b3a2a1644ee4d664ae6bcbc1 (MD5)
Previous issue date: 2010
en
dc.description.tableofcontents口試委員會審定書 i
致謝 ii
中文摘要 iii
Abstract iv
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 多重慢性病之介紹 4
第二節 醫療服務利用 7
第三節 慢性病患對醫療資源利用之影響 8
第四節 整合性照護的重要 10
第五節 成本效益分析 11
第六節 國內外慢性病及重複醫療利用之實證研究 13
第七節 文獻回顧小結 20
第三章 研究材料與方法 21
第一節 研究架構 21
第二節 研究假說 23
第三節 研究變項與操作型定義 24
第四節 研究對象及研究材料 31
第五節 資料處理與分析 34
第四章 研究結果 36
第一節 描述性統計分析 36
第二節 推論性統計分析 38
第三節 成本效益分析 45
第五章 討論 89
第一節 研究結果之討論 89
第二節 研究限制 97
第六章 結論與建議 98
第一節 結論 98
第二節 建議 101
參考文獻 102
附錄一、美國AHRQ以及CMS共同訂定之優先慢性病清單 104
附錄二、中央健康保險局建構整合式照護模式並逐步朝促進醫療體系整合計畫 105
附錄三、全民健康保險各總額部門歷年點值 116
dc.language.isozh-TW
dc.title整合式照護模式對65歲以上慢性病患醫療利用之可能影響zh_TW
dc.titlePotential Effect of Integrated Care Program on Medical
Utilization of Patients Above 65 Years Old with Chronic
Conditions
en
dc.typeThesis
dc.date.schoolyear98-2
dc.description.degree碩士
dc.contributor.oralexamcommittee蔡淑鈴,許怡欣
dc.subject.keyword慢性病,多重慢性病,全民健康保險,醫療利用,重複醫療,成本效益分析,zh_TW
dc.subject.keywordchronic conditions,multiple chronic conditions,National Health Insurance,health services utilization,overlapped medical utilization,cost-benefit analysis,en
dc.relation.page116
dc.rights.note有償授權
dc.date.accepted2010-08-03
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

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