安寧療護使用天數對末期病人醫療資源耗用之影響

The Impact of Length of Hospice Stay on Cost

10.6288/TJPH201534104039

陳雪姝(Sheue-Shu Chen)；謝秋萍(Chy ou-Ping Hsieh)；李幸諭(Hsin-Yu Lee)；蔡瓊玉(Chiung-Yu Tsai)；李哲瑋(Jhe-Wei Li)

安寧療護 ； 資源耗用 ； hospice care ； medical expenditure

台灣公共衛生雜誌

34卷4期（2015 / 08 / 01）

413 - 423

繁體中文

目標：以健保資料庫探討安寧天數對末期病患醫療資源耗用的影響，期以研究結果推動安寧療護觀念以減少無效醫療。方法：此為實驗對照研究，選取2013年死亡時67歲以上接受安寧之病患，依據性別、年齡、死前366天至730天醫療點數、特定疾病等變項與非安寧者進行1:1隨機配對，兩組各有7,890人。結果：兩組皆離死亡愈近資源耗用愈高，其中安寧組死前7天內之每人醫療點數較非安寧組為低，且其差值愈接近死亡愈明顯，從65點至2,325點。而安寧使用天數與死前0~10天及0~15天之每人費用成反比，安寧天數每多一天，費用減少523及598點；再與非安寧組比較，安寧天數越多點數節省越多，惟該現象於天數達9天及17天以上才顯現。結論：安寧療護可以節省資源，但安寧天數需相當或大於每人費用觀察期間的天數，才能觀察到其資源節省的效益。另精算，安寧組7,890人相較於非安寧組於死前7天內減少約6,056萬之醫療點數。

Objectives: To explore the impact of the length of hospice stay on the medical expenditure for terminally-ill patients by analysis of the database of National Health Insurance (NHI). Methods: This case-controlled study compared decedents over 67 years of age who were hospice users with non hospice decedents in 2013. After one-to-one random matching, there were 7,890 persons in each group. The variables used to create matches were age, gender, specific disease and the medical expenditure between the 366^(th) and 730^(th) days before the date of death. Results: Both hospice users and non hospice users had increased medical expenditure while approaching the date of death. In the 7 days before death, the medical expenditure per hospice users was 65 NT$ lower than that of non hospice users; the saving increased to more than 2,325 NT$ on the final day before death. The medical expenditure of within 10 days before death showed per hospice day reductions of 523 NT$. Conclusions: The longer the hospice stay, the greater the saving in medical expenditure.

1. 劉嘉年、楊銘欽(2007)。台灣癌症病患的健保安寧療護利用情形與費用分析。台灣衛誌，26，118-27。
   連結：
2. 羅健銘、陳素秋、賴允亮、林家瑾、陳建仁(2007)。住院癌末病患照護型態對住院醫療費用與住院天數之影響。台灣衛誌，26，270-82。
   連結：
3. Campbell, DE,Lynn, J,Louis, TA,Shugarman, LR(2004).Medicare program expenditures associated with hospice use.Ann Intern Med,140,269-77.
4. Greer, DS,Mor, V,Morris, JN,Sherwood, S,Kidder, D,Birnbaum, H(1986).An alternative in terminal care: results of the National Hospice Study.J Chronic Dis,39,9-26.
5. Lin, WY,Chiu, TY,Hsu, HS(2009).Medical expenditure and family satisfaction between hospice and general care in terminal cancer patients in Taiwan.J Formos Med Assoc,108,794-802.
6. Lo, JC(2002).The impact of hospices on health care expenditures- the case of Taiwan.Soc Sci Med,54,981-91.
7. Scheffey, C,Kestenbaum, MG,Wachterman, MW(2014).Clinic-based outpatient palliative care before hospice is associated with longer hospice length of service.J Pain Symptom Manage,48,532-9.
8. Tang, ST,Huang, EW,Liu, TW,Wang, HM,Rau, KM,Chen, JS(2010).Aggressive end-of-life care significantly influenced propensity for hospice enrollment within the last three days of life for Taiwanese cancer decedents.J Pain Symptom Manage,41,68-78.
9. Taylor, DH, Jr,Ostermann, J,Van Houtven, CH,Tulsky, JA,Steinhauser, K(2007).What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?.Soc Sci Med,65,1466-78.
10. Teno, JM,Casarett, D,Spence, C,Connor, S(2012).It is "too late" or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less.J Pain Symptom Manage,43,732-8.
11. 林庭伃(2011)。台北=Taipei，國立陽明大學醫務管理研究所=Institute of Hospital and Health Care Administration, National Yang-Ming University。
12. 羅紀琼(2002)。,台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan)。

1. 許添貴,林珊伊(2018)。探討死亡或病危自動出院的住院病人使用安寧療護服務概況。安寧療護雜誌，23(1)，18-34。
2. 林麗芬,林敬恒(2020)。從醫療政策與社會企業共同推動安寧居家療護－以結腸直腸癌為例。Journal of Data Analysis，15(3)，45-64。
3. 蘇珉一,鄭婉如,涂穎慧,馬瑞菊,林佩璇,李佳欣(2016)。安寧緩和醫療修法後對巴拉刈中毒末期病人醫療過程之影響。安寧療護雜誌，21(1)，46-60。
4. 謝佩琪、蕭嘉琪、楊雯淳、黃雅凰、李嬌容(2019)。提升血腫科病房護理人員善終準備執行率。長庚護理，30(4)，498-512。