癌症住院病患死亡前使用安寧療護與否之醫療費用的比較分析
A Comparison of Health Care Expenditure of Cancer Terminal Stage Care Between Hospice and Nonhospice Patients
中文摘要
整個醫療體系中瀕死階段是屬於高成本的健康照護，癌症照護是屬於高醫療成本 的，癌症為台灣十大死因之首，每年因癌症死亡的人數也逐年增加。本研究旨在 探討癌末臨終期病患在最後一次住院時接受安寧療護或傳統照護其醫療費用之 差異。
本研究對象為 2005 年 1 月 1 日至 2007 年 12 月 31 日期間，中央健保局住院醫療 費用明細檔之系統抽樣中死亡樣本。病患依照護型態分成安寧療護與傳統照護兩 組，分別串聯兩組健保住院費用檔與醫令檔，瞭解癌末臨終前醫療利用之現況並 比較兩組醫療費用之差異。
研究結果顯示，2005 - 2007 年癌症末期住院死亡病患總計 2,813 人，接受安寧療 護共 545 人，接受傳統照護共 2,268 人。在控制了病患和醫療機構特質等影響因 素後，整體的解釋力達 62.6％，癌末病患在臨終期住在安寧病房的天數比傳統病 房的天數少，使用安寧療護其醫療費用每人平均花費為 NT$37,334，卻比使用傳 統照護的醫療費用每人平均少 27.1％。
整體而言，安寧療護確實有達到節省成本支出的成效，但是接受安寧療護的癌症 末期病患的比率仍偏低。建議政府機關應支持安寧療護的發展，加強醫學教育及 民眾教育，讓癌症末期病患在臨終期能接受較合宜的照護方式，且未增加健保醫 療費用的支出。
英文摘要
Objective：The health policy analysis have noted the high cost of the care for the terminal stage patients, and that for the cancer patients is evenhigher. Cancer has become the leading cause of the death in Taiwan since 1982,and cancer deaths have significantly increased in recent years. The purpose of this study is to compare the expenditures of hospice and nonhospice cares of the terminal stage cancer patients.
Methods：The population of the study included all the 2,813 cancerous deaths in Taiwan between January and December, 2005-2007. The data released from the National Health Research Institutes for the inpatient expenditures by admission files were compared .The subjects were divided into twocategories, the hospice and nonhospice medical costs in the terminal stage cancer patients.
Results：Among the 2,813 cancer deaths, 545 of them chose hospice cares which made up 19.4% of the cases. The adjusted relationship between hospitalization costs
and the use of hospice care. It can be seen from this analysis that 62.6 %. The study disclosed that the interval
ofhospice stay for the terminal cancer patient is shorter, but the cost of the stay is cheaper, and is lesser by 27.1%.
Conclusion：We come to the conclusion that the hospice care for the terminal stage cancer patient has cost benefit. However, the acceptance rate is low which makes up only 19.4% of the case. We, therefore, suggest that the governmentally support in this very aspect is essential, as well as the development of hospice care for the terminal stage cancer patients.
