影響醫療區心導管醫療利用之相關因素－以1997~2005年為例; The Factors Associated with Utilization of Cardiac Catheterization in Health Care Regions—1997~2005

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 310903500/850

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题名:	影響醫療區心導管醫療利用之相關因素－以1997~2005年為例;The Factors Associated with Utilization of Cardiac Catheterization in Health Care Regions—1997~2005
作者:	康暐篁;Weai-Huang Kang
贡献者:	醫務管理學研究所碩士班
关键词:	醫院總額預算制度;心導管檢查與治療;高科技醫療利用;Global budget system;Cardiac catheterization treatment;High-tech medical utilization
日期:	2007-07-23
上传时间:	2009-08-12 16:22:46 (UTC+8)
摘要:	目的：高科技醫療被視為是造成醫療費用上漲的重要因素之一。由國內的資料顯示高科技醫療儀器當中以心導管檢查與治療使用次數成長最快。因此本研究針對台灣民眾心導管檢查與治療之使用情形進行瞭解，並深入探討其相關之影響因素，以作為衛生主管機關制定相關醫療政策之參考。方法：本研究依據1997-2005年間使用心導管檢查與治療的健保資料進行分析，以衛生署規劃的17個醫療區為觀察單位，分析健保實施後心導管檢查與治療之利用情形，並應用複迴歸分析探討影響醫療區心導管醫療利用的影響因素。結果：研究結果發現1997-2005年間，心導管使用次數呈現逐年快速增加的趨勢。1997年總使用次數為10,385人次，2005年上升至70,259人次，平均每年使用人次為44,108人次，9年成長率為576.54％，年平均成長率為27.0％；男性心導管醫療利用顯著高於女性，但若以成長率來看，則女性遠高於男性；65歲以上者的心導管利用率最高，但以成長率而言，45-54歲者的成長率已超過65歲以上者。複回歸分析結果顯示，女性人口比率、年齡及每百萬人口心導管儀器數皆為影響心導管使用密集度的顯著相關因素，並達統計上顯著水準(P<0.01)。結論：1997-2005年台灣心導管醫療利用呈逐年快速成長增加的趨勢，主要以年齡因素(45-54歲者)影響最大，代表罹患心血管疾病之年齡層有年輕化的現象；此外，總額實施後心導管檢查與治療的使用並沒有降低，另外醫療需求面及醫療供給面之因素對心導管檢查與治療利用皆有顯著的影響。 Objectives: Many studies have found that high-tech medical utilization is one of the most important factors on rising healthcare expenditure. Some studies pointed out that cardiac catheterization facilities were ranked as the highest utilization among high-tech medical instruments. Therefore, this study focused on the utilization of cardiac catheterization in Taiwan with emphasis on its impact on the government’s policy for the health care system. Methods: The study used the National Health Insurance (NHI) database from year 1997 to year 2005. According to the 17 healthcare regions which designed by the Department of Health, the study analyzed the utilization of cardiac catheterization facilities in each region after the national health insurance implemented. Multiple regression analysis was applied to analyze the factors associated with utilization of cardiac catheterization in healthcare regions. Results: The utilization of cardiac catheterization increased sharply year by year. The study found that the utilization was 70,259 person-time in year 2005 compared to 10,385 person-time in year 1997. The average utilization was 44,108 person-times per year. The growth rate for 9 year period (1997-2005) was 576.54%, and average growth rate was 27% per year. Males had significant higher utilization of cardiac catheterization than females. However, the growth rate for females was higher than males. The highest utilization of cardiac catheterization located in the group of patients’ age above than 65 years old. In the point of growth rate, patients’ aged between 45-54 years old had higher rate than the aged above than 65 years old. The result of multiple regression analysis showed that the proportion of female population, age, and number of cardiac catheterization facilities per million population were factors that influenced the utilization of cardiac catheterization (p<0.01) . Conclusions: The study indicated that utilization of cardiac catheterization increased year by year from 1997 to 2005. The most important factor was patients’ age (45-54 years old population). The result indicated that patients’ age for coronary heart disease was decreasing. Otherwise, the utilization of cardiac catheterization did not decreased after global budget system implemented. And the effects of medical demands (female population) and supplies (numbers of facilities) were significant factors that influenced the utilization of cardiac catheterization.
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