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| Title: | 乳癌疾病參與論質計酬之醫療資源與醫療支出分析
Medical Resources and Medical Expense Analysis of the Pay-for-Performance Program for Breast Cancer |
| Authors: | 劉宇程
Liu, Yu-Cheng |
| Contributors: | 周行一
Chow, Edward H.
劉宇程
Liu, Yu-Cheng |
| Keywords: | 乳癌
論質計酬
醫療資源
醫療費用
Breast cancer
Pay-for-performance
Medical resource
Medical expense |
| Date: | 2021 |
| Issue Date: | 2021-07-03 00:49:36 (UTC+8) |
| Abstract: | 研究背景與動機：癌症連續36年高居全國十大死因的第一名，說明癌症對於國人的健康具有極大的威脅；此外，乳癌的高發生率與高死亡率，亦說明乳癌對於婦女的健康具有極大的威脅。同時，伴隨台灣人口的高齡化、醫療科學持續進步的過程，延長人民的壽命，醫療科學的創新與人口結構轉變漸漸築高中央健康保險署的財務成本，健康保險之可持續性亦備受質疑。醫療資源耗用與醫療資源浪費亦迫使健康保險之財務負擔愈加沉重。儘管調整健保費率與補充保費費率，健康保險的永續不僅須依靠費率之調整，亦須配合良好的預算規劃與支付制度；同時，好的支付制度須考量成本的控制與醫療照護的品質。鑒於乳癌對於婦女的健康具有極大的威脅與支付制度的重要性，中央健康保險局於2001年建立「全民健康保險乳癌醫療給付改善方案」，目標係提升乳癌病患之醫療照護品質與建立醫療品質導向的支付方式；然而，多數醫療院所無參與乳癌醫療給付改善方案，且相關國內研究與文獻探討乳癌醫療給付改善方案較為缺乏。此外，鮮少研究探討論質計酬制度與全民健康保險財務成本之關聯。故此研究欲探討乳癌醫療給付改善方案之參與與否對於醫療資源耗用與醫療費用支出之影響。
研究材料與方法：此研究參考Wang et al. (2017)之研究架構進行設計，藉衛生福利資料科學中心之衛生福利資料檔案，挑選2001至2013年初次診斷罹患乳癌疾病之病患作為研究對象，藉資料篩選流程獲得實驗組—參與論質計酬方案之乳癌病患，與對照組—無參與論質計酬方案之乳癌病患，同時運用描述性統計與推論性統計，探討乳癌醫療給付改善方案之參與與否對於醫療資源耗用與醫療費用支出之影響。
研究結果：藉相關研究與文獻的分析和回顧，進行研究結果之相關推論。預期實驗組之病患集中多數診斷與治療於第一年，且預期藉完整之診斷與治療，有望降低病患之復發率，減少第一年後續的醫療資源耗用，進而有效減少追蹤期間之整體醫療資源耗用；此外，預期實驗組之整體重要醫療處置次數低於對照組，係因乳癌論質計酬制度藉診療指引，預期有效控制整體重要醫療處置次數。
結論與建議：伴隨台灣人口的高齡化、醫療科學持續進步的過程，延長人民的壽命，醫療科學的創新與人口結構轉變漸漸築高中央健康保險署的財務成本，健康保險之可持續性亦備受質疑。醫療資源耗用與醫療資源浪費亦迫使健康保險之財務負擔愈加沉重。論量計酬係依據醫療服務之提供者提供多少「醫療服務量」，即可獲得相應之費用支付，多數醫療服務提供者於醫療費用支付單價變動不大的情況，須仰賴醫療院所提供之醫療服務量，確保其能夠獲得一定之收入；此時容易造成過度耗用檢驗、治療或藥品等相關資源；此外，論量計酬方式未直接鼓勵病患進行整合性之照護，亦無標準化之診療與照護流程，醫療服務提供者過度重視醫療且缺乏關注預防或衛教，容易造就醫病非醫人的情況，可見論量計酬支付制度衍生的隱憂，亦顯示論質計酬支付制度時代的來臨。
Background and purpose: Cancer has been ranked first among the top ten causes of death in Taiwan for 36 consecutive years, indicating that cancer poses a great threat to the health of Taiwanese people. In addition, the high incidence and high mortality of breast cancer also indicate that breast cancer poses a great threat to women`s health. Meanwhile, with the aging of Taiwan’s population and the continuous advancement of medical sciences, people’s lifespans have been extended. Innovations of medical sciences and demographic changes have gradually increased the financial cost of the National Health Insurance Administration, and the sustainability of health insurance has also been questioned. The consumption of medical resources and the waste of medical resources have also forced the financial burden of health insurance to be heavier. Although the premium has been adjusted, the sustainability of health insurance must not only rely on the adjustment of the premium, but also good budget planning and payment system. Meanwhile, a good payment system should consider both cost control and quality of medical care. Given that breast cancer poses a great threat to women’s health and the sustainability of the payment system, the National Health Insurance Administration launched the pay-for-performance program for breast cancer in 2001. The goal of the program is to improve the quality of medical care for breast cancer patients and establish a payment system based on quality-oriented medical treatment. However, most medical institutions do not participate in the pay-for-performance program for breast cancer. At the same time, there is a lack of domestic research and literature on the pay-for-performance program for breast cancer. In addition, few researches discuss the relationship between the pay-for-performance program and the financial cost of health insurance. Thus, this study aims to analyze the consumption of medical resources and medical expense of the pay-for-performance program for breast cancer.
Materials and methods: The study was designed with reference to the research framework of Wang et al. (2017). Data of the study is obtained from the Health and Welfare Data Science Center (HWDC). Patients with newly diagnosed breast cancer from 2001 to 2013 were selected as the research subjects. Screening process was used to obtain the experimental group—breast cancer patients who participated in the pay-for-performance program, and the control group—breast cancer patients who did not participate in the pay-for-performance program. Descriptive statistics and inferential statistics were used to analyze the consumption of medical resources and medical expense of the pay-for-performance program for breast cancer.
Results: By analyzing and reviewing related researches and literature, the study make relevant inferences about the results. We expect that the patients in the experimental group will receive the majority of diagnosis and treatment in the first year. By receiving comprehensive diagnosis and treatment, we expect that the recurrence rate of patients in the experimental group will declined, and the medical resource consumption will be reduced in the following years, which will result in a decrease of the overall medical resources consumption. In addition, the total number of medical treatments of the experimental group is expected to be lower than that of the control group, due to the fact that the pay-for-performance program for breast cancer is based on the diagnosis and treatment guidelines, which is expected to effectively control the number of medical treatments.
Conclusion and suggestions: With the aging of Taiwan’s population and the continuous advancement of medical sciences, people’s lifespans have been extended. Innovations of medical sciences and demographic changes have gradually increased the financial cost of the National Health Insurance Administration and the sustainability of health insurance has also been questioned. The consumption of medical resources and the waste of medical resources have also forced the financial burden of health insurance to be heavier. The fee-for-service payment system is based on the amount of "medical service" provided by the medical institutions, and the corresponding fee payment can be obtained. Most medical service providers have to rely on the amount of medical services provided by themselves to ensure that they can obtain a certain income when the unit price of medical expenses does not change significantly, which will easily lead to excessive consumption of related resources such as testing, treatment or medicine. In addition, fee-for-service does not directly encourage patients to take integrated care, and there is no standardized diagnosis, treatment and care process. Meanwhile, medical service providers pay too much attention to medical care and lack attention to prevention or health education can easily lead to curing the disease but not curing the patient. It can be seen that the hidden worries derived from the pay-for-performance payment system, and also show that the era of pay-for-performance payment system is coming. |
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| Description: | 碩士
國立政治大學
財務管理學系
108357020 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0108357020 |
| Data Type: | thesis |
| DOI: | 10.6814/NCCU202100624 |
| Appears in Collections: | [財務管理學系] 學位論文
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| 702001.pdf | | 2287Kb | Adobe PDF2 | 0 | View/Open |
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