| 摘要: | 慢性腎臟病之高發生率與盛行率對國人健康已造成威脅，伴隨而來的龐大醫療費用更是不容小覷；慢性腎臟病發展至後期需要洗腎，在2007年台灣透析病患約為6萬人，雖佔全民投保人口約 0.26%，但是健保透析治療每年花費大約285億元，佔健保總預算的6.44%，其對健保財務造成不小衝擊。而腎臟移植是目前治療末期腎臟病的最好的治療方法。然而接受腎臟移植手術後，病人不只面對生理上的問題，也面臨許多心理與社會的壓力。因此，本研究擬針對慢性腎臟病病程的發展循序，探討慢性腎臟病的醫療費用結構、病程發展時間與相關因素、慢性腎臟病的診斷組合、透析治療的存活時間差異、不同治療方式的成本效果與成本效用，民眾、家屬和醫事照護人員對腎臟移植需求與看法，最後探討國內腎臟移植之醫療衛生政策。本研究分為兩個子計畫，子計畫一探討慢性腎臟病的費用結構、治療方式的成本效果、成本效用、病程發展與透析存活時間差異；子計畫二主要在蒐集國內外對於腎臟移植的倫理與衛生政策相關議題，並暸解民眾、家屬和醫事照護人員對腎臟移植需求與看法。本研究共分為兩期三年，第一期為期一年二個月，第二期為期一年十個月。子計畫一在第一期將藉由全民健保成人預防保健服務檢查單之檢查結果進行慢性腎臟病各分期的病患篩選，再藉由串連健保就醫資料，進一步分析慢性腎臟病各分期的醫療費用結構；同時利用國家衛生研究院之健保資料庫，以特殊需求申請1996年至2006年慢性腎臟病患與透析治療病患的就醫資料，探討影響慢性腎臟病病患與透析治療的醫療費用相關因素。此外，更採用實際病歷審查的方式蒐集病患臨床數據，分析不同治療方式、不同分期、不同地區病患之病況發展時間與趨勢、相關診斷組合、醫療利用影響因素。在第二期內，主要分析慢性腎臟病患與不同透析治療之的醫療利用趨勢，分析慢性腎臟病病程轉變時間的相關因素，及接受不同透析治療方式其病患的存活時間是否有所差異。同時以WHOQOL-BREF問卷進行慢性腎臟病患生活品質調查，蒐集2500位慢性腎臟病患之生活品質及臨床數據，分析病患生活品質及不同期之照護成本。並經由這些數據，瞭解哪些因素將影響病患生活品質，同時進行成本效果分析及計算獲得每一健康人年所需成本。另外，邀請國內外專家召開研討會，針對本研究之研究成果，分享與交流國內外有慢性腎臟病之相關議題，最後研擬慢性腎臟病健保給付制度，提供相關單位作為政策制訂的參考。 子計畫二則將在第一期與第二期，透過文獻回顧的方式，蒐集、彙整研究歐美、亞洲等已開發國家對器官移植的制度、法令、倫理立場與社會觀點。同時運用健保資料庫分析台灣地區過去與現在腎臟移植的現況。此外，針對民眾、家屬和醫事照護人員對腎臟移植需求與看法進行質性訪談調查，探討接受腎臟移植手術後病人在生理、心理、及社會層面可能面臨的問題。最後透過辦理國際專家研討會議，邀請國內外相關領域的專家，進行腎臟移植相關倫理、法律、政策議題進行研討，凝聚共識提出建言。
The high prevalence and high incidence of chronic kidney disease (CKD) was a threat to the health of Taiwan people and the huge health care expenditure of CKD should be paid attention. The dialysis population was around 60,000 in 2007. Although CKD patients were around 0.26 percent of HNI beneficiaries, the expenditure of dialysis in National Health Insurance (NHI) was 28.5 billion, which was 6.44 percent of NHI annual budget in 2007 and caused a serious financial burden for NHI. The kidney transplant is the best treatment method for end stage renal disease so far. However, after receiving kidney transplant surgery, the patients might face not only physical problems but also psychological and societal pressures. Therefore, this purposes of the study will be based on the development of CKD to explore health care expenditures, time for CKD development and related factors, related diagnoses of CKD, survival time for different dialysis treatments, and cost effectiveness analysis (CEA) and cost utility analysis (CUA) for different treatments. In addition, this study will investigate the needs and opinions of the general public, families, and medical personnel regarding kidney transplant, and finally will address policy reform recommendations regarding kidney transplant. This research consists of two studies. The first study will explore health care expenditures at different stage of CKD, CEA and CUA for different treatments, time for CKD development, and survival time for different dialysis methods. The second study will investigate the ethical legal and related policy concerning kidney transplant, and will examine the needs and opinions of the general public, families, and medical personnel regarding kidney transplant. This is a three-year study and has two periods. The first period is one year and two months. At the first study period, the first study will identify the different stage of CKD patients from the results of adult health examination and connect the CKD patients’ medical care utilization obtained from NHI claim data. The health care expenditures of the CKD patients in each stage will be analyzed. The medical care utilizations of CKD patients and dialysis patients from 1996 to 2006 will be obtained from National Health Research Institute’s (NHRI) NHI medical claim data. This study will use the data to investigate the factors affecting health care expenditure of CKD patients and dialysis patients. In addition, this study will review CKD patients’ histories and clinic data obtained from several hospitals, and will analyze related diagnoses of CKD, medical care utilization, and the time and trend of the development of CKD for different treatments, different disease stages, and different areas. At the second period, the first study will analyze the trend of health care utilization of CKD and dialysis patients, examine the factors related to the changes in disease stage for CKD patients, and will investigate whether the survival time is different for dialysis patients with different treatment methods. Moreover, this first study will also use the WHOQOL-BREF questionnaire as tool, collecting 2500 patients’ life quality data and clinical data, analyzing the life quality and the cost of care at different stages of CKD. Through gathering the data, this study tries to find out what influence will bring to the patients’ life quality by different treatment methods, and analyzes CEA and measures the incremental cost-effectiveness ration (per QALY gained). Finally, the international symposium will be held to share the research results, and discuss the related issues. This first study will also propose the national health insurance payment system for CKD and will provide the references to health policy makers. At the first period and second period, the second study will review the related literatures to investigate the ethical legal and social issues concerning organ transplantation and understand the related policy and law in developed countries. Based on the national health insurance database, the study will explore the past and current situation of kidney transplant in Taiwan. Using qualitative method, this study will investigate the needs and opinions of the general public, families, and medical personnel regarding kidney transplant. Finally, this study will hold international conference, and invite international experts to discuss the problems and issues concerning ethics, law, and policy in kidney transplant, and to search for consensus and guideline as well as to develop policy recommendation. |
