健保事前審查政策對手汗症手術之影響

中國醫藥大學機構典藏 China Medical University Repository, Taiwan > 公共衛生學院 > 醫務管理學系暨碩士班 > 博碩士論文 > Item 310903500/46257

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题名:	健保事前審查政策對手汗症手術之影響 The Impact of Changes in National Health Insurance Payment Policy on Undergoing Palmar Hyperhidrosis Surgery
作者:	賴詠譁;Lai, Yung-Hua
贡献者:	醫務管理學系碩士班
关键词:	手汗症;交感神經切除術;健保政策;事前審查;hyperhidrosis Palmaris;sympathectomy;bureau of national health insurance policy;precertification review policy
日期:	2012-07-19
上传时间:	2012-08-31 16:37:48 (UTC+8)
出版者:	中國醫藥大學
摘要:	目標：手汗症可能會嚴重影響病患生活品質，雖然手術是目前較理想的治療方式，但是術後的生活品質滿意度卻不是非常好，故健保局於2006年針對手汗症手術實施事前審查政策，本研究欲瞭解此政策對手汗症患者是否手術之影響及趨勢，並分析政策對不同病患及機構特性差異。方法：本研究利用2000年與2005年百萬人承保抽樣歸人檔，擷取1999-2009年間20歲以上ICD-9為780.8的手汗症患者。分析不同的病患特性、主要就醫機構特性是否影響手術情形。除描述性與雙變項分析，進一步以羅吉斯廣義估計方程式(GEE)進行推論性統計。結果：4,328位手汗症患者中接受手術者佔23.49%。探討接受手術的1016位患者，以女性(56.50%)、20-29歲(62.89%)、無重大傷病(98.13%)、共病嚴重度為0分(43.25%)、投保金額22800元以下(64.76%)、非低收(99.7%)、居住於台北分局(37.3%)、都市化程度為2&3級(47.05%)、私立醫院(42.91%)、地區醫院(35.24%)者居多。由GEE得知，顯著影響是否手術之相關因素為性別、年齡、政策實施、共病嚴重度、地區健保分局、都市化程度、主要就醫層級及權屬別。結論：手汗症手術趨勢從2000年(37.39%)逐年降低至2006年(0.79%)，政策實施後下降後幅度更大。個人特性、健康情形、給付政策、主要就醫機構特性為主要影響是否有手汗症手術之因素。 Objective: Hyperhidrosis palmaris could seriously affect the quality of life of patients. In spite that operations are regarded as the optimal treatment, the quality of life after the operation is not satisfactory. Aiming at hyperhidrosis palmaris operations, Bureau of National Health Insurance conducted the precertification review policy in 2006. This study tends to understand the effects of such a payment policy on the operation acceptance of hyperhidrosis palmaris and the trend. Moreover, the different impact of the policy on distinct patients and institutes are analyzed. Method: Based on 2000 and 2005 population-based National Health Insurance Research Database, hyperhidrosis palmaris patients with the age above 20 and ICD-9 being 780.8 within 1999-2009 were acquired for the analyses. In addition to descriptive analysis and bivariate analysis, logistic regression with Generalized Estimating Equations (GEE) is further utilized for inferential statistics. Results: Among 4,328 hyperhidrosis palmaris patients, 23.49% of them received the operations. 1,016 patients who accepted the operations, most of them were female (56.50%), aged 20-29 years (62.89%), without catastrophic illness(98.13%), Charlson comorbidity index score being 0 (43.25%), with the premium-based monthly salary below NT$22800 (64.76%), not low-income household (99.7%), and living in the area of Taipei branch (37.3%) with the urbanization degree 2 & 3 (47.05%), their medical treatment in private hospital(42.91%) or district hospitals (35.24%). From GEE, the significant factors in operations include gender, age, policy, comorbidity, branches of Bureaus of National Health Insurance, degree of urbanization, and the accreditation level and the ownership of the hospital. Conclusion: Hyperhidrosis palmaris operations dropped from 37.39% in 2000 to 0.79% in 2006, and the drop was even more obvious after the implementation of the precertification review policy. Personal traits, health conditions, payment policy, and the institutes’ characteristics were considered as the major factors in accepting hyperhidrosis palmaris operations.
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