醫師之住院醫療利用是否較具成本效果？

Do Hospitalized Physicians Consume Medical Resources More cost-effectively?

10.6288/TJPH2009-28-03-04

高毓翔(Yu-Hsiang Kao)；楊長興(Chiang-Hsing Yang)

醫師 ； 住院 ； 知情消費者 ； 全民健保資料庫 ； physician ； hospitalized ； informed consumer ； National Health Insurance Research Database NHIRD

台灣公共衛生雜誌

28卷3期（2009 / 06 / 01）

194 - 204

繁體中文

目標：探討身為知情消費者的醫師在住院時所使用醫療資源與治療成效相較於非醫師之醫療專業人員及一般民眾是否較具成本效果。方法：研究資料為1999年至2003年健保資料庫相關基本資料檔與門、住診檔案。採多重研究－對照之設計。對照組選取條件為：以醫師資料為主，經匹配性別與年齡後，分別對醫療專業人員與一般民眾進行1比1及1比10抽樣。最後利用複迴歸與邏輯斯迴歸檢視醫師、醫療專業人員與一般民眾在住院時醫療利用與治療成效上的差異。結果：經統計模式校正後，醫師在住院醫療資源利用(住院費用與高科技醫療利用率)顯著低於醫療專業人員與一般民眾；而治療成效（出院後14天內同疾病再入院）卻較佳。結論：在高時間機會成本的影響下，醫師較可能縮短其住院天數。此外，醫師具專業醫療知識，會尋求較具效率但未必昂貴的照護模式。結合此兩種因素可能導致醫師住院之成本較低。同時，由醫師的生活方式與習慣較為健康，加上可能的健康工人效應影響，亦會導致住院照護成效較佳。綜合上述所論，醫師之住院醫療利用具有較佳之成本效果。

Objectives: To assess whether hospitalized physicians, as informed consumers, use medical resources more cost-effectively? Methods: The data were drawn from National Health Insurance Research Database (NHIRD), for the period of 1999-2003. A case-control design was employed, and the study included three groups of subjects (physicians, non-physician health professionals, and the general population) matched for age and gender. Multivariate linear and logistic regression analysis was conducted to compare the utilization of medical resources and outcomes of treatment among these three groups. Results: Compared to non-physician health professionals and the general population, hospitalized physicians tended to consume significantly lower cost resources (have fewer high-tech procedures) and thereby incur less medical expense. Compared to the general population, hospitalized physicians derived significantly more benefit from their care (had lower readmission rates). Conclusions: Thus, the cost of hospitalizing physicians may be lower because the higher opportunity cost of time is related to shorter LOS and because physicians have more medical knowledge and are therefore more likely to seek more efficient but not necessarily more expensive inpatient care. Moreover, healthier behaviors and lifestyles together with a healthy worker effect are likely to contribute to the greater effectiveness of care of hospitalized doctors.

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