| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 97 === Background: The number of end-stage renal disease (ESRD) enrollees and meical expenditure in the world have increased dramatically. According to the USRDS statistics, the prevalence and incidence of Taiwan is the highest in the world. Several studies report that monthly costs of hemodialysis are higher than peritoneal dialysis with out-patient dialysis expenditure and the hemodialysis use among patient with ESRD in Taiwan is above 90%. According to this, the government wanted to reduce the Nation Health Insurance (NHI) expenditure by enhances the peritoneal dialysis (PD) use. The medical expenditure of caring a dialysis patient is not only dialysis-related but also non-dialysis-related medical services. Is it cheaper in total cost of PD then in HD in Taiwan? There has no answer so far. Objectives: To compare utilization of National Health Insurance (NHI) resources in terms of health expenses, either inpatient or outpatient expenses of dialysis-related and non-dialysis-related, between HD and PD patients. Material and Method: The study examines the impact of initial dialysis modality choice and subsequent modality switches on NHI expenditure in a 3-year period from first time dialysis treatment of each patient.The data was from the NHI claims data. This study also analyzed the influence of different variables, such as gender, age group, and disease severity, to two modalities of dialysis. Result: A total of 48565 incident patient from 1998~2004 were included in the analysis. Average annual total medical expenditure for PD is cheaper than HD, and the dialysis-related expenditure was the major. Compared to “HD, no switch” subgroup, “PD, no switch” had a significantly lower expenditure. Both expenditures of “HD, switch at second year” and “HD, switch at third year” had no difference with “HD, no switch” subgroup. In the contrary, the “PD, switch at first year” had a significantly higher expenditure. Conclusion: Initial modality choice and subsequent modality switches had significant implications for out-patient dialysis-related, out-patient non-dialysis-related, emergency medical service, in-patient-related expenditure on ESRD patients care.
|
|---|
