| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 96 === Background
According to the statistics released by the Bureau of National Health Insurance(NHI), annual growth of health expenditure is higher than GDP almost every year. Therefore, how to balance between revenue and expense of the NHI needs more attention for Taiwan government. Elderly Taiwanese, over sixty-five years old, accounted for over 7% of total population in 2008. Poor prevention in chronic diseases leading to treatments in acute situation is the main cause of accelerating the growth of medical expense. It will be helpful to the NHI if preventive care, instead of hospitalization, could be used to control or avoid hospitalization. A win-win situation between health providers and patients will reduce medical expenditure for government.
Research Objectives
1. To summarize common avoidable hospitalization for veterans base on National Health Insurance claim data,
2. To analyze avoidable hospitalization in all conditions, including hospital accreditation status, region, age and gender,
3. To compare how outpatient and hospitalization services in avoidable hospitalization among different elderly groups.
4. To provide policy implications for the BNHI to reduce unnecessary medical expenditure.
Method
This study analyzed 2005 NHI outpatient and inpatient claim data. Study subjects were selected from elderly veteran population whose age was over fifty-five and, low income, veteran relatives and unknown identity were all excluded from this study. Because identity of each claim record was scrambled, each sample was first merged by its scrambled ID and any missing record was removed from further analysis if poor data quality revealed. SPSS was used to perform statistical analyses and independent t test and ANOVA were conducted to test hypotheses.
Results
Chronic Obstructed Lung disease (PQI 5) is the most among avoidable hospitalization for veterans, 11,812 hospitalizations, or 29.53% of total avoidable hospitalization. The second is bacteria pneumonia (PQI 11), 11,456 persons, 28.64%. The 3rd is urinary-tract infection (PQI 12), 5,972persons, 14.93%. The 4th is venous stasis heart failure (PQI 18), 3,753 persons, 9.38%. The 5th is diabetes mellitus (PQI 3), 2,020 persons, 5.05%.
Conclusions
According to a statistic released by the Veteran Affairs of the Executive Yuan that states over 75% of veterans whose age are over 70 use outpatient services. Among them, 19% go to medical centers and 44.8% use outpatient services provided by clinics. Veterans usually seek care from doctors working in military and/or veteran hospitals, it is mainly because quality of care of primary care services in many regions are not acceptable to them. Two kinds of avoidable hospitalization, bacillary disease and urinary-tract infection, for veterans were caused by three chronic diseases, chronic obstructed lung disease, venous stasis heart failure and diabetes mellitus in chronic disease. It indicates the discrepancy of attention demand, the unbalanced of medical treatment resources, the insufficient of approaching medical treatment and poor quality of initial medical attention. Majority of veterans living in Veteran House seek care from doctors working in veteran hospital and medical posts. Most of them were over 81 years old, on average, and in seriously ill; besides many of them had chronic diseases, including non-unity disease, mutual diseases or mixed with mental disorder. It can explain high utilization of medical services for veterans and major causes of using avoidable hospitalization. Therefore, I suggest:
1. health authorities should:
(1) Use avoidable hospitalization diseases as indices of quality and monitor primary outpatient services.
(2) Continue to adopt disease management skills to reduce severity of hospitalization due to co-morbidity and complication which resulting heavy payments.
(3) Increase health education, injecting vaccination including pneumonia, influenza vaccine and perform health examinations for veterans so that their avoidable hospitalization can be reduced.
(4) Promote quitting smoking behaviors which started before veteran’s retirement.
2. Health providers should ：
(1) Promote the concept of avoidable hospitalization and reduce demand for unnecessary medical care through regular community services so that avoidable hospitalization can be avoided..
(2) Cooperate with other Medical facilities, such as community care and rehabilitation is necessary if the concept of avoidable hospitalization wanted to take effect in existing health care market.
|
|---|
