醫師臨終之醫療資源耗用：醫師病人是否不同？

Physicians' Medical Resource Consumption at the End of Life: Do Physician-Patients Behave Differently?

10.6288/TJPH2012-31-03-04

連怡甄(Yi-Jen Lien)；楊長興(Chiang-Hsing Yang)

生命末期 ； 知情消費者 ； 醫師病人 ； 同儕禮遇 ； 全民健保資料庫 ； end stage of life ； informed consumer ； physician-patient ； peer courtesy ； National Health Insurance Research Database (NHIRD)

台灣公共衛生雜誌

31卷3期（2012 / 06 / 01）

236 - 250

繁體中文

目標：比較醫師與一般民眾在生命末期之醫療資源耗用是否有差異，並探索影響醫師生命末期醫療資源耗用之因素。彌補醫師病人生命末期醫療資源利用是否有差異之研究缺口。方法：利用1999至2003死因資料檔與全民健康保險資料庫中基本資料檔及住院檔加密後串聯，以醫師性別、死亡年齡、原死因別進行1:10配對抽樣選出對照組樣本（一般民眾），並利用複迴歸以及邏輯斯迴歸比較醫師與一般民眾死亡前六個月住院醫療耗用以及特殊醫療利用是否有差異。結果：醫師死亡前六個月住院總醫療費用、每次住院醫療費用、加護病房利用率、加護病房總住院天數等，均顯著皆高於一般民眾。結論：醫師在生命末期時其醫療費用顯著高於一般民眾。醫師成為病人時角色既獨特且具挑戰性，他們的醫師可能基於情誼給與同儕禮遇，在挽留同儕生命所做的決策可能與照護一般民眾有異。

Objectives: To assess the differences in medical resource consumption at the end of life between physicians and the general public, and to explore possible reasons for this in order to help fill the gap in research on medical resource consumption by physician-patients at the end of life. Methods: The data were drawn from encrypted Death Registry and National Health Insurance claims from 1999 through 2003. A sample of the general public (the comparison group) was drawn at a ratio of 10:1 relative to the physician sample, and was matched by gender, age and primary cause of death. Both multivariable linear regression and logistic regression analyses were conducted to compare hospital care and specific services used in the six months prior to death by the two groups. Results: Total hospital care expenses, expenses per admission, the utilization rate of intensive care units, and the length of stay in the six months prior to death were significantly higher for physicians than for the general public. Conclusions: Physicians account for substantially higher expenses at the end of life than does the general public. Physicians, as unique and challenging patients, may influence their treating physicians to adopt special lifesaving strategies out of fellowship or courtesy.

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