| 摘要: | 研究背景及目的 依據中央健康保險局統計，89年因氣喘就診個案數計有499,110 人（以89年1-10月推估），其中18 歲以上患者有309,610 人約佔62％，總計一年共花費醫療費用約19.6 億（中央健保局，2002）故國內氣喘病衍生的照護費用，亦是一筆龐大醫療支出。
氣喘隨著人類身處環境的複雜而有更趨嚴重的狀態，氣喘的治療費用很高，本研究期望在有限資源下，衡量單獨使用西醫、中醫或中西醫合併對氣喘治療的效益進行分析比較，提供一項證據醫學的研究，期望能作為臨床研究或決策上另一種參考依據。
研究方法 本研究之資料來源：以1996年至2003年國家衛生研究院全民健保學術研究資料庫中之承保抽樣歸人檔「門診處方及治療明細檔」為資料來源。針對ICD9為493 (氣喘)做其醫療利用及耗用分析。
統計軟體：以SAS 9.1.3套裝軟體進行統計之計算醫療成本及Excel 2003套裝軟體繪圖及表格，再以成本效益分析（Cost Benefit Analysis，CBA）計算出其成本效益比。最後進行描述性及分析性統計分析。計算成本效益比值，中西醫與西醫之成本效益比為1.73、中西醫與中醫之成本效益比為-0.54。故在中西醫治療氣喘費用上，每多花1元，在西醫得到1.73元的效益，而在中醫反而虧損0.54元。研究顯示建議現階段應以中醫治療氣喘為主，使能達到控制成本之目標。
研究建議 （一）對衛生主管機關之建議：本研究結果西醫,中西醫治療氣喘尚未具效益，故建議現階段以中醫治療氣喘為主；而目前探討氣喘成本效益具爭議，建議政府編列預算於這方面之研究。（二）對醫院管理者之建議：落實氣喘個案管理方案並運用實證醫學之精神，尋找適當的治療方式，以兼顧照護品質及成本控制。（三）對後續研究者之建議：將併發症醫療耗費成本加入考量並進行特定族群長時間之趨勢分析；另外再針對天生過敏體質的病患進一步研究；最後同時配合問卷調查，納入病患間接成本，其研究結果將更為準確。
關鍵字：氣喘、中醫治療、中西醫治療、成本效益分析、論病例計酬、 論人計酬、診斷關係群、合理門診量、總額支付制度、
Abstract
Background and Objective: According to the statistical data from Bureau of National Health Insurance(NHI), there were 499,110 cases of asthma (from January to October) in 2000. Approximately 62% or 309,610 of the patients were over 18 years of age. The expenditure on medical treatment for asthma was around 1.96 billion dollars in total a year (Bureau of NHI, 2002). As a result, the amount of expenditure for treating asthma contributes to considerable medical expenses.
The more polluted environment becomes, the severer asthma cases are prone to be. The medical expenses on treatment for asthma are getting higher. The study is aims to analyze and compare the benefits of western medicine, Chinese medicine and the combination of Chinese and western medicine on asthma treatment in limited condition in order to provide evidence-based medicine (EBM) study as a reference for clinic research or policy-making.
Methodology: Source of Data for the Study: Prescriptions from Outpatient Services and Details on Treatment, National Health Insurance Research Database, National Health Resource Institutes are the source of the data. In light of ICD9 as 493, the study is aims to analyze the medical use and consumption.
Statistics Software: Firstly, SAS 9.1.3 is employed to calculate medical treatment costs; Excel 2003 software package is employed for graphics and charts. Secondly, Cost Benefit Analysis (CBA) is employed to calculate the cost-benefit ratio. Lastly, descriptive and analytical statistical analyses are employed.
Results and Conclusions: The cost-benefit ratio of the combination of Chinese and western medicine to western medicine is 1.73; the cost-benefit ratio of western medicine to Chinese medicine is 19.24. Thus every one dollar spent on the combination of Chinese and western medical treatments of for asthma benefits 1.73 dollars on western medical treatment and western medical treatments no benefits and more cost than Chinese medical treatment.
Based on the study, therefore, it is highly recommended that Chinese medical treatment be taken in order to obtain the goal of being cost-effective.
Suggestions: (1) Suggestions for authorities: the result of the study is that western medical treatment and the combination of Chinese and western medical treatments for asthma are not cost-effective, so Chinese medical treatment is highly recommended for the time being. In addition, probing into cost of and benefit from asthma is controversial. It is suggested that government authorities budget for research pertaining to asthma. (2) Suggestions for supervisors at hospitals: case management and empirical medical research should be carried out to find proper treatment so that both quality of care and cost control can be taken care of. (3) Suggestions for Future Researchers: medical expenses on complications should be taken into consideration and focus groups should be studied for a long period of time. Moreover, patients who are allergic by birth should be studied further. Finally, questionnaires should be implemented and indirect cost of patients should be included to make results of studies more precise.
Key Words: Asthma, Chinese medical treatment, western medical treatment, Cost-benefit Analysis, Case Payment, Capitation Payment, Diagnosis Related Groups, Proper Capacity for Outpatient Services, Global budget, |
