腹腔鏡腹股溝疝氣修補術之住院病患特質及醫療費用相關因子

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題名:	腹腔鏡腹股溝疝氣修補術之住院病患特質及醫療費用相關因子 Inpatients’ Characteristics and Factors Related to Medical Utilization in Laparoscopic Inguinal Hernia Repair
作者:	林玟欣 Lin, Wen-Hsin
關鍵詞:	腹腔鏡腹股溝疝氣修補術;醫療利用;健保資料庫;臨床資料庫 Laparoscopic Inguinal Hernia Repair;Medical Utilization;NHI;Clinical Database
日期:	2018
上傳時間:	2019-01-02 09:19:59 (UTC+8)
摘要:	近年來，使用腹腔鏡進行疝氣修補術之比例逐年上升，醫界認為此手術之醫療資源利用變異大，目前採實支實付的支付方式。了解手術之病患特質及醫療費用相關因子，將有助於醫療機構檢討及控管支出，也有助於健保署正確分類DRG及合理給付醫療費用。本研究使用全民健康保險研究資料庫承保抽樣歸人檔(1997年至2010年)及台北某區域級醫療機構臨床資料庫資料(2008年至2015年)，並以因腹股溝疝氣而住院且當次住院有接受腹腔鏡疝氣修補之個案為研究對象，再依病患特質、合併症、醫師及醫院特質、治療方式及併發症等，分析病患特質並探討醫療費用之相關因子。本研究中，健保資料庫共納入240人，臨床資料庫共納入925人，研究結果發現病患年齡層分布皆以45-64歲的中年族群最多，65歲以上的老年族群次之，男性病患個案數遠大於女性、肥胖患者的腹股溝疝氣發生率低於正常體重或超重者；在各項醫療費用中，以特殊材料費與總醫療費用之相關強度最高，醫療費用相關因子包括有病患年齡分組、疝氣側性及類型、就醫科別及住院天數。腹腔鏡腹股溝疝氣修補術之住院總醫療費用呈現逐年上升趨勢，此疾病除了好發於中、老年男性，年齡愈大，住院總醫療花費也愈多，主要原因與病患年紀愈大，雙側疝氣的比例愈高(1.2倍)、罹患慢性疾病的比例愈高有關。欲進行有效管理，醫療機構可進一步分析相關醫療科在醫療費用結構上的差異，針對差異做改善；政策制定者也應再就病患年齡、單或雙側疝氣，重新檢視醫療費用之差異，合理給付醫療費用。 In recent years, the proportion of laparoscopic hernia repair has been increasing yearly. Health care provider considers that the medical utilization in this operation is highly variable, and Fee-for-service payment adopted currently. This retrospective study used the NHI database (1997-2010) and clinical database of a regional hospital in Taipei (2008-2015). Patients who were hospitalized due to inguinal hernia and had accepted laparoscopic hernia repair were the subjects of the study, then further analyzes the characteristics of inpatients and the factors related to medical utilization. Total 240 patients were included in NHI database, 925 patients were included in clinical database. Age distribution was most common among 45-64 years old, followed by above 65 years old, male were far more than female, and the incidence was lower in obesity. The correlation between materials and total medical expenses were the highest. Factors related to medical utilization were patients'' age, sides and types of hernia, departments and length of stays. Medical expenses of laparoscopic inguinal hernia repair show an upward trend yearly. This disease was more common in older patient, who also spends more medical expenses. The main reason was that the older the patient, the higher the proportion of bilateral hernia(1.2 times) and combined with chronic diseases. For management, medical institutions can further analyze the differences in the structure of medical expenses in departments, and make improvements to the differences. Governments should also review the differences and make reasonable payments.
描述:	碩士指導教授：張偉斌
資料類型:	thesis
顯示於類別:	[醫務管理學系暨研究所] 博碩士論文

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