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

ADVOCATE HOME-BASED HOSPICE CARE THROUGH PUBLIC HEALTH POLICIES AND SOCIAL ENTERPRISES: AN EXAMPLE OF COLORECTAL CANCER

10.6338/JDA.202006_15(3).0004

林麗芬(Lie-Fen Lin)；林敬恒(Ching-Heng Lin)

安寧居家療護 ； 商業保險 ； 全民健康保險 ； 醫療費用 ； Home-based hospice care ； Commercial insurance ； National health insurance ； Medical expenditure

Journal of Data Analysis

15卷3期（2020 / 06 / 01）

65 - 85

繁體中文

安寧療護設置的目的，是要維護生命末期病人全人化的照顧，提升病人與家屬較佳的生活品質。本研究使用健保資料庫中2009－2011年結腸直腸癌末期病患，在臨終前90天與14天的總費用分析中，使用安寧居家療護的住院費用比未用安寧療護者，分別節省15%和42%的醫療費用支出，故臨終前曾使用安寧居家療護，可以有效的減少無效醫療及健保費用支出，對末期病患是一項值得推動的政策。從商業保險角度，檢視現行保險商品對於安寧居家療護的保障缺口，建議新增安寧居家療護保障之保險金，可解決病患的財務負擔，提高安寧居家療護的利用率，企業與政府共同倡導良好的公共醫療政策，可提升醫療政策的效益。

The purpose of hospice care is to improve the quality of life of terminally ill patients, increase family care satisfaction. This study analyzed the end-stage colorectal cancer patients from 2009 to 2011 in the National Health Insurance Research Database. Hospitalization expenditure with respect to 90 days and 14 days before death for using home-based hospice care (HBH care) are 15% and 42%, respectively, less than those who do not use hospice care. Therefore, by advocating HBH care is a worthwhile policy of end-of-life patients, can reduce futile treatments and national health insurance medical costs effectively. From the perspective of commercial insurance, this study examines the current insurance products for the security gap of HBH. Accordingly, an additional commercial insurance product pays the HBH care benefit is suggested. This insurance benefits can reduce the financial burden of end-life patients and improve the HBH care utilization rate. Play the role of a social enterprise and advocate a good public medical policy together to enhance the common interests of the nation.

1. 翁瑞萱,徐愫萱,施至遠,黃勝堅(2015)。臺灣社區安寧居家療護之現在與未來。護理雜誌，62(2)，18-24。
   連結：
2. 陳雪姝,謝秋萍,李幸諭,蔡瓊玉,李哲瑋(2015)。安寧療護使用天數對末期病人醫療資源耗用之影響。台灣公共衛生雜誌，34(4)，413-423。
   連結：
3. 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。台灣公共衛生雜誌，26(2)，118-127。
   連結：
4. 龍紀萱,李依臻(2018)。護理之家實施安寧療護服務措施之研究。台灣公共衛生雜誌，37(6)，638-650。
   連結：
5. Aranda, S.(1999).Global perspectives on palliative care.Cancer Nursing,22(1),33-39.
6. Canadian Institute for Health Information(2007).Health care use at the end of life in Western Canada.Ottawa:CIHI.
7. Chang, S.,Long, S. R.,Kutikova, L.,Bowman, L.,Finley, D.,Crown, W. H.,Bennett, C. L.(2004).Estimating the cost of cancer: Results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000.Journal of Clinical Oncology,22(17),3524-3530.
8. Chen, L. F.,Chang, C. M.,Huang, C. Y.(2015).Home-Based Hospice Care Reduces End-of-Life Expenditure in Taiwan A Population-Based Study.Medicine,94(38),e1693.
9. Dawson, N. J.(1991).Need satisfaction in terminal care settings.Soc Sci Med,32(1),83-87.
10. Dumont, S.,Jacobs, P.,Fassbender, K.,Anderson, D.,Turcotte, V.,Harel, F.(2009).Costs associated with resource utilization during the palliative phase of care: a Canadian perspective.Palliative Medicine,23(8),708-717.
11. Hospice UK. (2015). How hospices can help the NHS improve choice and reduce costs for end of life care. Retrieved from https://www.hospiceuk.org/media-centre/facts-and-figures
12. Kizawa, Y.,Morita, T.,Hamano, J.,Nagaoka, H.,Miyashita, M.,Tsuneto, S.(2013).Specialized Palliative Care Services in Japan: A Nationwide Survey of Resources and Utilization by Patients With Cancer.American Journal of Hospice & Palliative Medicine,30(6),552-555.
13. Klinger, C. A.,Howell, D.,Marshall, D.,Zakus, D.,Brazil, K.,Deber, R. B.(2013).Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project.Palliat Med,27(2),115-122.
14. 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,101(8),552-559.
15. McCarthy, E. P.,Burns, R. B.,Ngo-Metzger, Q.,Davis, R. B.,Phillips, R. S.(2003).Hospice use among Medicare managed care and fee-for-service patients dying with cancer.Jama-Journal of the American Medical Association,289(17),2238-2245.
16. National Hospice and Palliative Care Organization. (2016). History of Hospice Care. Retrieved from https://www.nhpco.org/hospice-care-overview/history-of-hospice/
17. Sleeman, K. E.,Davies, J. M.,Verne, J.,Gao, W.,Higginson, I. J.(2016).The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993-2012.Palliative Medicine,30(1),45-53.
18. Slomp, M.,Jacobs, P.,Ohinmaa, A.,Bland, R.,Block, R.,Dewa, C. S.,Wang, C.(2012).The Distribution of Mental Health Service Costs for Depression in the Alberta Population.Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie,57(9),564-569.
19. Tang, P. L.,Chiou, C. P.,Lin, H. S.,Wang, C.,Liand, S. L.(2011).Correlates of Death Anxiety Among Taiwanese Cancer Patients.Cancer Nursing,34(4),286-292.
20. Tang, S. T.(2003).When death is imminent - Where terminally ill patients with cancer prefer to die and why.Cancer Nursing,26(3),245-251.
21. Tang, S. T.,Huang, E. W.,Liu, T. W.,Rau, K. M.,Hung, Y. N.,Wu, S. C.(2010).Propensity for Home Death Among Taiwanese Cancer Decedents in 2001-2006, Determined by Services Received at End of Life.Journal of Pain and Symptom Management,40(4),566-574.
22. Taylor, D. H.,Ostermann, J.,Van Houtven, C. H.,Tulsky, J. A.,Steinhauser, K.(2007).What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?.Social Science & Medicine,65(7),1466-1478.
23. Wood, D. J.,Clark, D.,Gatrell, A. C.(2004).Equity of access to adult hospice inpatient care within north-west England.Palliative Medicine,18(6),543-549.
24. World Health Organization. (2013). Definition of palliative care. Retrieved from Accessed 06 September 2017 http://www.who.int/cancer/palliative/definition/en/
25. Yabroff, K. R.,Lamont, E. B.,Mariotto, A.,Warren, J. L.,Topor, M.,Meekins, A.,Brown, M. L.(2008).Cost of care for elderly cancer patients in the United States.Journal of the National Cancer Institute,100(9),630-641.
26. 吳孟嬪,璩大成,馮容莊,黃勝堅(2015)。建構跨專業之都會型社區安寧療護模式。北市醫學雜誌，12，116-129。
27. 吳莉芬,賴慧文,潘雪幸(2011)。一位肺癌末期病患接受安寧療護之護理經驗。腫瘤護理雜誌，11(1)，37-47。
28. 林芳如,黃勝堅,吳春桂,黃美玲,林亞陵,蘇玲華,林宏茂(2010)。重症生命末期無效醫療之探討。中華民國急救加護醫學會雜誌，21(S)，1-8。
29. 林敬恒,林麗芬(2016)。105年度臺中榮總與逢甲大學合作研究計畫成果報告105年度臺中榮總與逢甲大學合作研究計畫成果報告,台中:逢甲大學。
30. 林敬恒,林麗芬(2017)。106年度臺中榮總與逢甲大學合作研究計畫成果報告106年度臺中榮總與逢甲大學合作研究計畫成果報告,台中:逢甲大學。
31. 唐高駿,藍祚運(2014)。393公民平台393公民平台,未出版
32. 翁益強(2011)。安寧居家療護。健康世界，302，51-55。
33. 陳佳佳(2014)。生命盡頭的尊重。全民健康保險雙月刊，111，10-15。
34. 黃肇明,施華菁,劉嘉仁,黃勝堅,黃遵誠(2015)。臺北市立聯合醫院安寧療護現況及未來需求分析。北市醫學雜誌，12，9-20。
35. 楊志良(2011)。全民健保的迷思。科學人雜誌，114，74-76。
36. 趙可式(2009)。台灣安寧療護的發展與前瞻。護理雜誌，56(1)，5-10。
37. 衛生福利部 (2019b)。衛生福利部全民健康保險會第4屆108年第 4次委員會議紀錄。檢自 https://dep.mohw.gov.tw/NHIC/cp-1655-48350-116.html
38. 衛生福利部 (2017)。106年度死因統計結果。檢自https://www.mohw.gov.tw/cp-16-41794-1.html
39. 衛生福利部 (2019a)。衛生福利部全民健康保險會總額評核會議資料及評核結果，104~108年各部門總額(含門診透析)一般服務執行成果報告。檢自https://dep.mohw.gov.tw/NHIC/cp-1664-48419-116.html
40. 蕭雅倫,林明慧,黃怡璇,張曉婷,黃信彰(2013)。子宮頸癌末期高齡病患接受安寧病房住院照護與急性病房住院照護之比較性研究－台灣健保資料庫分析。安寧療護雜誌，18(1)，24-38。