Risk Factors of Medical Expenses at Different Treatment Stages of Dialysis Patients

• Main Authors: Tzu-Yu Lin, 林子郁
• Other Authors: Lin-Wen Mau
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/11703679495156145934

碩士 === 高雄醫學大學 === 公共衛生學研究所 === 90 === Risk Factors of Medical Expenses at Different Treatment Stages of Dialysis Patients Abstract Background and Objectives Facing the increasing dialysis expenses, the Bureau of National Health Insurance has adopted capitation payment system with the mechanism of risk-adjustment. However, it should be noted that significant variations in medical expenses existing among different treatment stages of end stage renal disease (ESRD). Therefore, the major purpose of this study was to examine ESRD patients’ service utilization and associated medical expenses at different dialysis stages; furthermore, to identify the influential risk factors of medical expenses for each dialysis stages; and to compare the differences in order to establish a valid risk-adjusted model of medical expenses. Methods This study design was cross-sectional. Anderson medical allocation model was the basis for study theoretical framework, which included individual characteristics (that is, predisposing factors, enabling factors, need factors), prior utilization, organization attributes for analysis. The study sample comprised of total hemodialysis patients in Kaohsiung-Pingtung areas in 2000. According to the initial timing of dialysis, the dialysis patients were further classified into clinical acute stage, disability stage, and dying stage patients. The data sources were derived from the annual survey (2000) of Taiwan Society of Nephrology database and corresponding medical expense claim files from the Kao-Ping Branch of the Bureau of National Health Insurance. Results 1. The highest mean value of total medical expenses per individual per month was found in patients at dying dialysis stage, followed by clinical acute stage, and disability stage. 2. The structure of medical expenses (per patient per month) varied in different dialysis stages. The major portions of medical expenses for patients at disability stage referred to regular dialysis expenses. For patients at clinical acute stage, no significant difference was found in the expenses for regular dialysis expenses and inpatient care. For patients at dying stage, most of medical expenses contributed to hospitalization. 3. According to the results of simple regression analysis, the need factor was the most significant factor associated with total medical expenses for patients at clinical acute stage. For patients at disability stage, prior utilization was the most significant factor, followed by the need factor. For patients at dying stage, the most significant factor was the need factor, followed by prior utilization. 4. With respect to the risk-adjusted models at different dialysis stages, the model for the patients at disability stage had the highest adjusted R2 from 17.6%to 55.0%: followed by the model for the dying stage (Adj. R2=17.6%-28.9%); the lowest value of adjusted R2 (3.1%-5.2%) was found in the model for clinical acute stage. Discussion and Suggestions The present study found that significant differences in services utilization and total medical really existed among different treatment stages in ESRD patients. The risk-adjusted model for the disability dialysis stage had the most significant power for the prediction of total medical expenses, which could serve as the basis for designing risk-adjusted capitation payment system for ESRD patients at the disability stage patients. For the patients at clinical acute stage patients, the lower prediction power for the risk-adjustment model limited the generalizability of the results. It is suggested that more risk factors need to be taken into consideration for future research on ESRD patients at clinical acute stage and dying stage, which is the major group with the most likelihood of “adverse selection” for hospitals. In conclusion, it is critical to establish risk-adjusted models according to different dialysis stages of treatment needs.