建議

本研究可看出 1997 年至 2006 年癌症患者死亡前一年的醫療費用 與總體醫療費用佔率皆有明顯增加，為了醫療資源合理運用應加深民 眾對癌症預防之認識，政府己積極推動癌症防治之相關工作於九十二 年五月公布施行「癌症防治法」，更衍生出「國家癌症防治五年計畫」， 相關工作包括：強化國人對癌症防治三段五級預防方法之認知，避免 癌症危險因子；宣導檳榔危害健康及開發拒嚼檳榔介入計畫模式；整 合縣市衛生局及醫療院所資源，提供民眾主要癌症（子宮頸癌、乳癌、

結直腸癌及口腔癌）篩檢服務；培訓癌症篩檢醫事人力及推動癌症篩 檢品質提升計畫；建立台灣地區癌症登記資料庫，提供癌症相關流行 病學資料；建立整合性的癌症防治服務機制，補助醫院辦理「癌症防 治中心-全面提升癌症診療品質計畫」；推動辦理安寧療護宣導並於非 安寧病房推廣安寧共同照護服務；建立癌症病友支持網絡及結合民間 團體提供癌症病友服務等。

總之政府應更積極以制度與預算引導醫院深入各鄉鎮村里推動 癌症防治。工作重點包括：一、癌症篩檢：目標是早期診斷、早期治 療，例如人類乳突腫瘤病毒(HPV)疫苗公費補助施打，以減少子宮頸 癌發生率、加強慢性B型及C型肝炎抗病毒藥物治療以減少肝癌發生率 及推廣戒煙門診以減少肺癌發生率等；二、民眾衛教，希望能將癌症 預防與早期治療的知識深植入基層民眾的習慣裡；三、醫院內癌症團 隊的教育訓練，目標是培養出更多具有癌症防治的專業從業人員，並 且建立民眾與醫院間溝通的管道，期望建立資訊互通的平台；四是提 升癌症病患的照護品質，達到令人照護，身、心、靈兼顧的安寧療護。

同時為了拓展癌症防治之財源除了目前之「菸品健康福利捐」外，應 可考慮加徵檳榔稅與烈酒稅。

本研究局限於西醫醫療費用，但臺灣癌症患者常會尋求中醫治 療，所以建議後續研究者可深入探討中醫醫療費用；同時 20 歲以下 癌症患者最少但醫療費用却是最高，應進一步分析其冶療內容與費用 成長趨勢以作為政策制訂之参考。

第三節 研究限制

一、本研究中死亡的定義以退保為依據，若患者出國就醫或經濟因素 等其他原因而退保或雖為癌症却因其他原因而死亡者都會高估 母群體數。

二、估算依賴 ICD 診斷碼，存在 ICD-9 建立的準確性的偏差。

三、癌症相關醫療費用以主診斷為癌症 ICD 診斷碼者才採認列入統 計，恐有低估之嫌。

四、在臺灣癌症病患常會尋求中醫治療，所以只研究西醫醫療費用可 能會比實際值低。

五、由於費用明細來自健保申報資科，缺乏替代療法(alternative medicine)與民眾自費醫療(out of pocket)的部份，所以無法反應癌 末病患的醫療費用全貌。

六、癌症資料庫無法提供癌症期別或手術複雜度等臨床變項，使疾病 嚴重度的控制上會有所不足。

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