Determinants of Medical Care Expenditures for ESRD Hemodialysis Patients

• Main Authors: Bi-Yu Chang, 張碧玉
• Other Authors: Lih-Wen Mau
• Format: Others
• Language: zh-TW
• Published: 2001
• Online Access: http://ndltd.ncl.edu.tw/handle/74902192814473791920

碩士 === 高雄醫學大學 === 公共衛生學研究所 === 89 === Objectives The major purpose of this study was to identify the determinants of medical care expenditures for the End-Stage Renal Disease(ESRD) hemodialysis patients, which may serve as a basis to establish a risk-adjustment payment system for a general scale. Methods and Materials The study design is based on a cross-sectional study. The study population were ESRD patients who lived in Kaohsiung-Pingung areas and were older than 18 years. In total, there were 2,385 ESRD subjects. Retrospective data were used, which included patients files from the Taiwan Society of Nephrology, and the claim data from the Kaohsiung-Pingung Branch of the Bureau of National Health Insurance. Results The results indicated that age, education, diabetics, and previous-year medical expenses were significant predictive of medical expenditures, which explained 45.3﹪of variances in ESRD patients’ ambulatory expenditures. Specifically, the prior utilization factor had greatest predictive power; 43.6﹪of variances were explained. Discussion The uniqueness of the study is to integrate the data from the Taiwan Society of Nephrology, and the Bureau of National Health Insurance, and to evaluate the appropriateness of applying capitation to ESRD patients. The capitation system can be improved by extending the set of risk adjusters. Without risk adjustment, capitation rates are likely to overpay or underpay medical care expenditures for ESRD hemodialysis patients. The study results were limited by a cross-sectional model. We recommend a longitudinal model to repeated measure and evaluate the goodness of fit and stability of different risk adjusted models for ESRD payments.