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| Title: | 以全民健康保險資料庫探討國人慢性疾病的現況
The Empirical Study of Chronic Diseases based on Taiwan National Health Insurance Database |
| Authors: | 林渤越
Lin, Po Yueh |
| Contributors: | 余清祥
林渤越
Lin, Po Yueh |
| Keywords: | 人口老化
全民健康保險
慢性病處方箋
標準死亡比
醫療利用
Aging Population
National Health Insurance
Chronic Disease Refillable Prescriptions
Standardized Mortality Ratio
Health Care Utilization |
| Date: | 2013 |
| Issue Date: | 2014-07-14 11:30:04 (UTC+8) |
| Abstract: | 壽命延長意謂老年時間比例增加，因此老年人罹患慢性疾病機率、醫療利用高於其他年齡層，預期未來醫療需求將隨人口老化而大幅上升；另外，國人十大死因與慢性病有關者也佔多數，例如：癌症、糖尿病、腦血管等疾病，其中癌症已連續31年為死因之首。為因應人口老化的需求，本文以慢性疾病為研究目標，透過全民健保資料庫的投保、就醫紀錄，分析國人罹患慢性疾病的相關資訊，包括：哪些慢性病較為普遍、需要較多醫療資源、死亡率較高等，作為政府規劃醫療政策的參考。另外，有別於其他慢性病研究多半選擇某幾項疾病，本文以領取慢性病處方箋者為對象。
本研究使用全民健康保險資料庫2005年百萬人抽樣檔（資料期間2003-2011年），包括承保資料檔(ID)、門診處方及治療明細檔(CD)以及住院醫療費用清單明細檔(DD)，以領取西醫慢性病連續處方箋者為研究對象，探討這些人的個人特性及就醫行為。研究發現截至2011年，慢性病連續處方箋盛行率的成長速度高於人口老化，且盛行率隨年齡增加而上升，其中女性盛行率高於男性，發生率則不相上下。比較特別的是，整體慢性病連續處方箋死亡率較全國高，但領取處方箋的高齡人口死亡率卻低於全國同齡人口，而領取處方箋的女性之死亡率低於同齡領取處方箋男性。進一步分析發現，領取處方箋者的平均罹病個數微幅成長，慢性病之間並不獨立。此外，老年人口就醫確實較為頻繁，儘管領有慢性處方箋的患者其醫療利用率略高於整體老年患者，但其差異性較一般年齡層來的小。
Living longer also indicates a longer time after the retirement. The elderly have higher chance of suffering from chronic diseases and their medical expenditures are thus much higher than those of other age groups. It is expected that the national medical expenditure will increase because of the rapid population aging. The prolonging life also suggests the shifting of main death causes to chronic diseases related, such as cancer, diabetes mellitus, and cerebral vascular disease. (Cancer has been the leading death cause in Taiwan for more than 30 years.) To meet the needs of an aging population, the goal of this study to explore the chronic diseases in Taiwan, based on Taiwan National Health Insurance Database. Also, unlike other studies for chronic diseases, the target subjects in this study are those who have chronic disease refillable prescriptions.
In the study, the database used is the one million samples chosen in 2005, including their ID (personal identification), CD (out-patient visit), and DD (in-patient visit) records. We found that up to 2011, the overall prevalence rate of chronic disease refillable prescriptions grows faster than that of elderly proportion. Furthermore, both the prevalence and incidence rates are higher in women. Also, the mortality rates of younger people with chronic disease refillable prescriptions are higher than the national average, but those of elderly with chronic disease refillable prescriptions are lower than the national average. We also found that the people with chronic disease refillable prescriptions are likely to have other chronic diseases. Moreover, the difference in the numbers of out-patient between people with and without chronic disease refillable prescriptions is larger for younger age groups. |
| Reference: | 一、中文部份
王培東(2006)，“疾病發生的測量：發生率(Incidence) 和盛行率 (Prevalence)”， 台灣醫界，第49卷，第4期。
李世代、范碧玉、黃麗秋、簡雅芬(1999)，全民健康保險慢性病ICD-9-CM分類
代碼之研議，衛生福利部中央健康保險署。
李世代(2000)，全民健康保險慢性疾病建議代碼，衛生福利部中央健康保險署。
吳肖琪、李曉玲(2013)，“台灣慢性病人醫療利用之探討—以慢性腎臟病、糖尿病及高血壓為例”，台灣衛誌；第32卷，第3期：231-239頁。
吳瑞堯、周駿賢(2009)，“運用資料探勘技術於六大死因慢性疾病之研究”，資訊管理學報，第18卷，第1期：187-211頁。
林瑞益(2006)，應用資料探勘技術於全民健康保險研究資料庫-以慢性腎衰竭為
例，私立大同大學資訊經營學系碩士學位論文。
胡月娟、陳敏麗(2005)，慢性病護理學，匯華圖書出版有限公司。
連賢明(2008)，“如何使用健保資料進行經濟研究”，經濟論文叢刊，第36卷．第1期：115-143頁。
黃碧玉(2007)，糖尿病患者使用慢性病連續處方箋對門診醫療利用之影響，國立台灣大學公共衛生學院衛生政策與管理研究所碩士學位論文。
陳惠姿(2007)，“整合性照顧系統”，護理雜誌，第54卷，第5期：5-10頁。
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大學管理學院資訊管理學系碩士學位論文。
二、英文部分
Brown, R.L. (1997). “Introduction to the Mathematics of Demography.” Actex Publications, 3rd Edition.
Curtin, M. and Lubkin, I. M. (1995). “Chronic illness impact and interventions.” What is Chronicity, pp. 3-25, edited by I. M. Lubkin, 3rd Edition, Boston Jones & Bartlett.
Keyfitz, N. (1985). “Applied Mathematical Demography.” New York : Springer.
Meydani, M. (2001). “Nutrition Interventions in Aging and Age-associated Disease.”
Annals of the New York Academy of Sciences 928: 226–235.
Murdock, S.H. and Ellis. D.R. (1990). “Applied Demographic: An Introduction to Basic Concepts, Methods, and Data.” Westview Press.
Omodei, D. and Fontana. L. (2011). “Calorie Restriction and Prevention of Age-associated Chronic Disease.” FEBS Letters 585(11): 1537-42.
Sarkar, D. and Fisher. P.B. (2006). “Molecular Mechanisms of Aging-associated Inflammation.” Cancer Letters 236(1): 13-23.
Sekar, C.C. and Deming. W.E. (1949). “On a Method of Estimating Birth and Death Rates and the Extent of Registration” Journal of the American Statistical Association 44: 101-115. |
| Description: | 碩士
國立政治大學
統計研究所
101354010
102 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G1013540101 |
| Data Type: | thesis |
| Appears in Collections: | [統計學系] 學位論文
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