台灣慢性病人醫療利用之探討－以慢性腎臟病、糖尿病及高血壓為例

Medical Utilization by Patients with Chronic Diseases in Taiwan: Chronic Kidney Disease, Diabetes and Hypertension

10.6288/TJPH2013-32-03-03

李曉伶(Hsiao-Ling Lee)；吳肖琪(Shiao-Chi Wu)

慢性腎臟病 ； 糖尿病 ； 高血壓 ； 醫療利用 ； chronic kidney disease ； diabetes ； hypertension ； medical utilization

台灣公共衛生雜誌

32卷3期（2013 / 06 / 15）

231 - 239

繁體中文

目標：人口老化導致慢性病人及醫療利用增加，實施論量計酬導致多重疾病病人至不同專科看病，探討慢性病人之醫療利用及其照護適用情形有其重要性。方法：以健保門住診資料定義2006年底仍存活之20歲以上慢性病人（患慢性腎臟病、糖尿病、高血壓）為對象，計算2006年底慢性病盛行情形，排除2007年死亡者追蹤其2007年醫療利用，探討慢性病型態對門住診醫療利用之影響。結果：2006年底20歲以上至少罹患一種慢性病者共2,539,137人，盛行率為14.83%；合併三種慢性病者之門診及住院利用最高，平均門診次數、科別數、醫師數、院所數分別為33.20次、5.41科、8.46位、4.57所，平均住院次數、天數、院所數分別為0.71次、7.37天、0.43所；合併三種慢性病、合併慢性腎臟病及高血壓者之門診利用顯著較僅罹患高血壓者高，合併三種慢性病、合併慢性腎臟病及糖尿病者之住院利用顯著較僅罹患高血壓者高。結論：慢性病型態會影響門診和住院利用。建議衛生主管機關提供適度之支付誘因，鼓勵及引導醫師提供多重慢性病人整合性照護，給予病人較佳之治療建議。

Objectives: An aging population has more individuals with chronic diseases and greater medical utilization. In a fee-for-service payment system, patients tend to visit different specialists for their various conditions. This study analyzed the impact of patterns of chronic disease on medical utilization. Methods: This study used the National Health Insurance database to identify patients who had been diagnosed with chronic kidney disease, diabetes or hypertension, were aged 20 or older, and were alive at the end of 2006. The study measured the prevalence of chronic diseases in 2006 after excluding the patients who died in 2007. The study then analyzed current medical utilization by patients with chronic diseases. Results: There were 2,539,137 patients with at least one chronic disease in 2006, and the prevalence rate was 14.83%. The highest medical utilization was by patients with all three chronic diseases. For outpatient care, the numbers of visits, different departments, different physicians, and different hospitals/clinics were 33.20, 5.41, 8.46 and 4.57, respectively. For inpatient care, the average numbers of visits, hospital days, and hospitals/clinics were 0.71, 7.37 and 0.43, respectively. Outpatient utilization by patients with three chronic diseases and patients with chronic kidney disease and hypertension were significantly higher than those of patients with hypertension alone. Inpatient utilization by patients with three chronic diseases and patients with chronic kidney disease and diabetes was significantly higher than that of patients with hypertension alone. Conclusions: Patterns of chronic diseases influence medical utilization. We suggest that health authorities provide appropriate financial incentives to encourage physicians to provide services and better treatment recommendations for patients with multiple chronic conditions.

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