CT及MRI醫療利用與影響費用因素

Utilizations of CT and MRI and the Factors Associated with Expenditure

10.6288/TJPH2005-24-06-07

蔡文正(Wen-Chen Tsai)；龔佩珍(Pei-Tseng Kung)；楊志良(Chih-Liang Yaung)；江怡如(Yi-Ju Chiang)

電腦斷層攝影掃描儀 ； 核磁共振掃描儀 ； 高科技醫療利用 ； 高科技儀器 ； CT ； MRI ； High-tech Medical Utilization ； High-tech Equipment

台灣公共衛生雜誌

24卷6期（2005 / 12 / 01）

529 - 538

繁體中文

目標：全民健保實施後，高科技醫療的使用成為醫療費用上升的主要因素之一。高科技貴重儀器中以電腦斷層攝影機(CT)及核磁共振掃描儀(MRI)之醫療費用最高，本研究探討電腦斷層攝影機(CT)及核磁共振掃描儀(MRI)醫療利用情形，分析影響其醫療費用之相關因素。方法，以台灣全民健保資料庫之全國申報資料，針對1998至2001年四年間CT及MRI利用情形，分析CT及MRI門診與住院醫療利用率及成長趨勢，並應用複迴歸分析找出影響CT及MRI醫療費用之相關因素。結果：2001年CT與MRI門診每千人利用率為1.38與0.45，住院每千人利用率為87.28與15.96。1998至2001年CT與MRI之門診年平均成長率為4.47%與18.54%，CT與MRI住院年平均成長率為-2.52%與4.90%。CT及MRI之門診利用率仍高成長，而住院利用率成長較趨緩。MRI於儀器較低密度區成長快速，CT成長則明顯較小。一週內CT及MRI在門診與住院多次利用率逐年顯著下降。在控制其他變項下，一地區的CT或MRI儀器人口比、醫院醫師人口比、女性人口比率對每人每年CT或MRI使用費用呈顯著正相關；但是一地區平均家戶所得對CT及MRI之利用費用為顯著負相關。幼兒人。比率及老年人口比率對CT或MRI之費用無顯著影響。結論：醫療供給面因素的增加，對CT及MRI之費用成長影響較大，而醫療需求面中之人口年齡結構的變化則較無影響。藉由審查管理制度的介入，對CT及MRI多次利用的監控有一定的成效。

Objectives: Following the implementation of National Health Insurance, high-tech medical devices have become one of the main factors causing an increase in health care expenditure. Among the expensive medical devices, CT and MRI have the highest expenditure. This study investigates CT and MRI utilization and the factors that affect CT and MRI expenditure in Taiwan. Methods: This study used nationwide CT and MRI claim data for the years 1998 to 2001 from BNHI in Taiwan. We analyzed the trend of CT and MRI utilization at outpatient and inpatient services. Multiple regression analysis was the statistical method to determine the factors that influence the expenditure on CT and MRI. Results: In 2001 the rate of CT and MRI utilization for outpatients was 1.38 and 0.45 per 1000 patients, and the rate of inpatient use was 87.28 and 15.96 per 1000 patients. From 1998 to 2001, the annual growth rates in CT and MRI utilization for outpatients were 4.47% and 18.56%, whereas the annual growth rates for inpatients were -2.52% and 4.90% respectively. The rate of CT and MRI utilization for outpatients is still growing at an increasing rate while it become stable for inpatients. The multiple use of CT or MRI procedures in one week has significantly decreased. The CT or MRI-population ratio, hospital-based physician-population ratio, and female ratio have a significantly positive relationship with CT or MRI expenditure after controlling for other factors. Average family income significantly has a negative relationship with CT or MRI expenditure. However, the proportion of pediatric (≤14 years) population and aged (≥65 years) population didn't significantly influence CT or MRI expenditure after controlling for other factors. MRI and its utilization increase rapidly in areas with a low MRI-population ratio, whereas increases in CT units and utilizations have distinctly lower rates. Conclusion: Increases in supply-side health care resources have had more impact on the growth in CT and MRI expenditure than that of demand side. However, changes in the population's age structure will not significantly increase CT or MRI expenditures. The utilization review policy was an effective control on the multiple use of CT or MRI.

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