A Medical Resources Utilization Research on the Long-Term Care Institutions and Residents Based on the Database of the Bureau of National Health Insurance of Taipei Branch

• Main Authors: Ling-Chen Shen, 沈鈴珍
• Other Authors: Chia-Ding Hou
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/01675601697284806953

碩士 === 輔仁大學 === 應用統計學研究所 === 96 === The scope of aging population has an obvious increase year by year in Taiwan, and resulted in significant medical expenditure in the long-term care of chronic patients. This study used random samples from the medical institutions contracted with the Bureau of National Health Insurance from January 2005 to the end of December 2006. The number of medical institutions that provided health services in long-term care institutions was 5,519. The methodology of this study includes Automatic Interaction Detector (CHAID), chi-square test, one-way and two-way ANOVA, correspondence analysis, multiple comparison analysis, Kruskal-Wallis test, T test, and logistic regression analysis. The analysis results showed that most medical resources are used by the internal medicine department (outpatient visit: 2-3 or 4-5 times/per month). In addition, the majority of patients is in the district hospital, and the mean of the medical resource utilization is other departments (outpatient visit: 4-5 times/per month). The hospital level and the number of outpatient visits have effected on the medical expenditure. The total medical expenditure is very high in Taipei County. In the regional and public hospitals, the medical expenditure and the medical resource utilization are lower; however, the medical expenditure in district hospitals is high. Furthermore, the highest medical resources utilization for long-term care institutions and residents is in long-term care centers, and the lowest is in long-term care institutions and disabled institutions. Hospital with good accreditation would spend more medical expenditures than those with poor accreditation. The lowest medical expenditure is in Taipei City, and the majority of residents have no social benefits. Females use more medical resources than males do, but males are hospitalized longer than females. The medication period for females is more than that for males. The majority of outpatient visits are at the internal department, but the highest amount of application and total medical expenditure is in other departments. The medical resource that is used by residents of long-term institutions is not high, and the length of medication period is usually 15-28 days. It can be seen that more medical resource utilization may not lead to longer hospitalization period or higher total medical resource expenditure. The results of logistic regression analysis showed that the odds ratio of the medical resource utilization in clinics to medical centers is 0.111; the odds ratio of the medical resource utilization in surgical department to internal department is 13.132; the odds ratio of the medical resource utilization of outpatient visits 4-5 times/ per month to the outpatient visits once per month is 2.003; the odds ratio of the medical resource utilization by long-term care institutions with poor accreditation to those with good accreditation is 1.178; the odds ratio of the high medical resource utilization to low utilization is 0.816. Future studies could probe into how to achieve a balance between health service for the elder and medical expenditure, for building an integrated long-term care medical system, and reducing the waste of medical resources. In conclusion, an important issue for the National Health Insurance System is to maintain a financial balance.