台灣癌症病患的健保安寧療護利用情形與費用分析

Utilization of and Expenditures for Palliative Care for Cancer Patients under the National Health Insurance in Taiwan

10.6288/TJPH2007-26-02-04

劉嘉年(Chia-Nien Liu)；楊銘欽(Ming-Chin Yang)

癌症 ； 全民健保 ； 安寧療護 ； 醫療利用度 ； 醫療費用 ； Cancer ； National health insurance ； Palliative care ； Health care utilization ； Health care expenditure

台灣公共衛生雜誌

26卷2期（2007 / 04 / 01）

118 - 127

繁體中文

目標：分析台灣癌末病患對健保安寧療護的利用度、費用以及使用者特性。方法：以2001-2004年全民健康保險資料庫之門、住診資料，篩選符合癌症診斷且曾經接受過健保安寧療護服務者為研究對象，分析其整體住院安寧病房與居家安寧門診的人次與費用，及其在病患性別與年齡別的差異。結果：台灣癌症病患每年使用居家、住院安寧療護或兩者皆使用的人數，自2001年的4,633人逐年增加為2004年的6,426人，佔各年因癌症死亡人數的14.0%-17.7%之間，健保給付安寧療護服務的總費用，自2001年的2.14億逐年增加到2004年的2.83億，並以支付住院安寧療護為主佔89.2%-94.0%。使用安寧療護服務最多的前五項癌症診斷為肺癌、結腸直腸癌、肝癌、口腔癌、胃癌。醫學中心與區域醫院是癌症病患主要的求醫場所，合計的門診與住院人次分佔總人次的70.5%與92.3%，80%的安寧療護費用支付給6縣市的醫療機構。結論：台灣癌症病人使用安寧療護之比率較國外為低且集中於醫學中心，宜增強安寧療護的資源分布並向病患及家屬宣導，以提昇癌末病患照護品質。

Objectives: To explore the utilization of and health care expenditures for palliative care and characteristics of palliative care-seeking for cancer patients in Taiwan. Methods: As our sample, we selected cancer patients who had used palliative care from the outpatient and hospital claims data of the Bureau of National Health Insurance (BNHI) between 2001 and 2004. We explored total palliative care use and expenses, age and gender, and differences in in-patient hospice care and outpatient visits of hospice home care. Results: A total of 4,633 persons used hospice or hospice home care in 2001; this increased to a total of 6,426 persons in 2004, representing 14.0%~17.1% of the total number of cancer patients treated between 2001 and 2004 in Taiwan. Total expenditures for palliative care for cancer patients increased from NT$214 million in 2001 to NT$283 million in 2004. Hospice care accounted for 89.2%-94.0% of all palliative care expenses. The five leading cancer diagnoses of palliative care patients were lung, colorectal, liver, oral, and gastric cancer. Medical centers and regional hospitals were major places of palliative care-seeking for cancer patients, accounting for 70.5% of hospice home care visits and 92.3% of hospice admissions. Among all healthcare institutions receiving payment for palliative care expenses, 80% were located within 6 cities or counties. Conclusions: Utilization of palliative care for cancer patients in Taiwan was lower than in other countries and was concentrated in medical centers. In order to improve end-of-life care for cancer patients, we suggest that NHI should encourage hospitals to provide more palliative care resources and educate the general public about the benefits of palliative care.

1. (2005)。行政院衛生署：中華民國九十三年衛生統計。
2. (2004)。行政院衛生署：國家癌症防治五年計畫（草案）。
3. (1995).The SUPPORT Principal Investigators.A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Rink of Treatment (SUPPORT),274,1591-8.
4. (2005)。中央健康保險局：中華民國全民健康保險統計，2004年。
5. Bowman K W,Martin D K,Singer P A(2000).Quality end-of-life care.J Eval Clin Pract.
6. Bruera E,Neumann C M,Gagnon B(1999).Edmonton regional palliative care program: impact on patterns of terminal cancer care,161,290-93.
7. Campbell D E,Lynn J,Louis T A,Shugarman L R(2000).Medicare program expenditures associated with hospice use.Ann Inern Med.
8. Centeno C,Hernansanz S,Flores L A,Pubiales A S,Lopez-Lara F(2002).Spain: palliative care programs in Spain, 2000: a national survey.J Pain Symptom Manage,24,245-51.
9. Coleman R E(2003).Current and future status of adjuvant therapy for breast cancer.Cancer,97,880-6.
10. Earle C C,Neville B A,Landrum M B,Ayanian J Z,Block S D,Weekd J C(2004).Trends in the aggressiveness of cancer care sear the end of life.J Clin Onclo,22,315-21.
11. Emanuel E J,Young-Xu Y,Levinsky N G,Gazelle G,Saynina O,Ash AS(2003).Chemotherapy use among Medicare beneficiaries at the end of life.Ann Intern Med.
12. Eve A,Higginson I(2000).Minimum dataset activity for hospice and hospital palliative care services in the UK 1997/98.Palliat Med.
13. Eve A,Smith A M(1996).Survey of hospice and palliative care inpatient units in the UK and Ireland, 1993.Palliat Med,10,13-21.
14. Greer D S,Mor V,Morris J N,Sherwood S,Kidder D,Birnbaum H(1986).An alternative in terminal care: results of the National Hospice Study.J Chronic Dis.
15. Lackan N A,Ostir G V,Freeman J L,Mahnken J D,Goodwin J S(2004).Decreasing variation in the use of hospice among older adults with breast, colorectal, lung, and prostate cancer.Med Care.
16. Liu C N,Yang M C(2002).National health insurance expenditure for adult beneficiaries in Taiwan in their last year of life.J Formos Med Assoc.
17. Lo J C(2002).The impact of hospices on health care expenditures-the case of Taiwan.Soc Sci Med.
18. McCarthy E P,Burns R B,Ngo-Metager Q,Davis R B,Phillips R S(2003).Hospice use among Medicare managed care and fee-for-service patients dying with cancer,289,2238-45.
19. McCarthy E P,Phillips R S,Zhong Z,Drewn R E,Lynn J(2000).Dying with cancer: patients` function, symptoms, and care preferences as death approaches.J Am Geriatr Soc.
20. Prechel R E,Colberg J W(2003).Surgery, brachytherapy, and external-beans radiotherapy for early prostate cancer.Lancet Oncol.
21. Saunders D C,Saunders D C,Kastenbaum Reds(1997).Hospices worldwide: a mission statement.Hospice Care on the International Scene,1-12.
22. Virnig B A,Kind S,MeBean M,Fisher E(2000).Geographic variation in hospice one prior to death.J Am Geriatr Soc.
23. WHO(2002).National Cancer Control Programs: Policies and Managerial Guidelines
24. 唐秀治、陳美伶、林嘉莉(2004)。利用健保申報資料探討癌症病人臨終前一年接受醫療照護的情形
25. 唐秀治、劉滄梧、賴美淑(2004)。台灣地區非安寧照顧下癌症末期病人及家居臨終照護需求與喜好及臨床照護現況評估
26. 莊榮彬(2005)。安寧共同照顧簡介。安寧療護雜誌，10，39-43。
27. 莊榮彬、李英芬、邱泰源(2005)。安寧共同照護模式試辦經驗。安寧療護雜誌，10，234-42。
28. 楊銘欽、劉嘉年、林金龍(2001)。全民健保制度下民眾臨終前一年之醫療資源耗用分析
29. 趙可式(2001)。安寧療護住院服務試辦論日計酬之監控與評估計畫。
30. 羅紀琼(2002)。安寧療護住院服務試辦論論日計酬之評估－試辦效益分析。

1. 蔡欣芸(2018)。安寧緩和醫療對生命末期照護品質及醫療費用之相關性探討─以肺癌病人為例。國立臺灣大學健康政策與管理研究所學位論文。2018。1-128。