| 摘要: | 經濟負擔程度是影響醫療可近性的重要因素。全民健保實施以來，病患就醫所產生的自付費用，一直是其經濟負擔的主要項目，本研究目的為瞭解癌症病患就醫自付費用額度、其佔全年家庭總收入之百分比，並探討自覺經濟負擔程度及其影響因素。 為方便研究進行，立意取樣研究對象為中部某一醫學中心及某一區域教學醫院就醫之血癌、肺癌、乳癌之病患。以結構式問卷表自91年3月至4月進行資料收集，共計訪查204位癌症病患，其中血癌計25人、肺癌計90人、乳癌計89人。問卷經過專家內容效度及再測信度，其一致性為85.75%，由訪員進行電話訪查、門診訪視、住院訪視等方式收集資料。統計分析以t-test、 ANOVA、Duncan’s multiple range test事後檢定與Kruskal-Wallis 檢定不同類別在自付費用的差異，以複迴歸分析影響經濟負擔的因素。 研究結果癌症病患於民國90年一年之平均自付費用為308,744元，平均家庭年收入損失113,426元，70%以上的年收入是用於癌症治療的自付費用，經濟負擔程度屬於中度程度。西醫門診次數、住院天數及家庭總收入為影響癌症病患經濟負擔程度的因素之一。 比較不同癌症別病患就醫自付費用是否不同，發現血癌病患平均自付費用顯著高於(p<0.01)肺癌及乳癌病患，血癌病患平均703,081元、肺癌病患為253,885元、乳癌病患為236,950元；血癌病患中，在止吐藥物(5,844元)、檢查費用(2,372元)、病房費(37,102元)的花費顯著高於肺癌及乳癌患者的花費；比較不同癌症別的經濟負擔程度，血癌病患為6.99級(10級表經濟負擔程度十分沉重)，顯著高於肺癌及乳癌病患，肺癌病患平均為5.37級，乳癌病患平均為4.41級，乳癌及肺癌病患在不同醫院層級的就醫病患其自覺經濟負擔無顯著差異。花費於中醫治療的費用上，於傳統中醫治療的自付費用，乳癌病患平均一年花費近6,741元，而肺癌病患為7,092元，在健保中醫的花費上，乳癌病患花費(2,529元)顯著高於肺癌患者(121元)(p<0.01)。; The purpose of this study was to quatify the out-of-pocket expenditure, to estimate the percentage of whole family yearly income spending on the out-of-pocket health care, to determinate the degree of the financial burden and the related factors for the patients with leukemia, lung and breast cancer. The study was designed as a cross-sectional survey. The convenience sample consisted of 204 respondents at various stage of disease, who were interviewed at one medical center and one area hospital in central Taiwan from March to April, 2002. The structural questionnaire was investigator developed, which was conducted by content-validity and the test-retest reliability level was 85.75%. There were 25 leukemia patients, 90 lung cancer patients and 89 breast cancer patients included in this study. Data were analyzed using t-test、 ANOVA、Duncan’s multiple range test, Kruskal-Wallis and multiple regression. Results show that the cancer patients have spent an average of $308,744 or over 70 percent of their income on the out-of-pocket for health care in 2001. The loss of income was not calculated as out-of-pocket expenditure, the mean of the loss income was amounted to $113,426. The significant related factors of the financial burden were the frequency of outpatient visit, the length of stay and whole family yearly income. Comparison of the out-of-pocket expenditure by the type of cancer, the expense of leukemia patients (mean $703,081) was statistically significantly higher (p<0.01) than lung cancer patients($253,885) and breast cancer patients ($236,950). On a scale of 0 (low) to 10 (high), the mean financial burden of leukemia patients was 6.99, also statistically significantly higher (p<0.01) than lung cancer patients (5.37) and breast cancer patients (4.41). In comparison with out-of-pocket on chinese medicine covered by NHI (National Health Insurance), the respondents with breast cancer spend more than lung cancer patients ($2,529 and $121)(p<0.05). The annual out-of-pocket expenses on traditional chinese medicine not covered by NHI was $6,741 for patients with breast caner, and $1,290 for lung cancer patients. The conclusion of this study was the extend of out-of-pocket expenditures may depend on ease of symptom management. The recognition of the out-of-pocket expenditures enables nurses and physician to anticipated the financial burden of illness and make necessary referrals. Key ward: out-of-pocket expenditure, financial burden, cancer patient. |
