| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 98 === Background: Accroding to USRD 2009 Annual Report, the incidence and prevalence rates of ESRD in Taiwan were the highest around the world. Total Medicare spending for ESRD rose 6 percent—5.8 percent of the entire Medicare budget. Identifying the factors that affect the occurrence of ESRD has become the government and the public concern issue. Previous research has demonstrated that regional variation in incidence of ESRD, and the environment factors impact the incidence. However, studies of this field is still lacking in Taiwan. The objective of this study is to evaluate regional differences in the incidence of ESRD, and identify the risk factors of the environment associated with the geographic variability of ESRD.
Material and Method: The dataset used in this study is from the NHI claims data, a total 62,856 incident patient from 1999-2007 were included. Take advantage of Moran’s I and LISA indicators to exhibit spatial clustering in Taiwan’s 359 townships. Utilizing spatial regression model to identify the regional factors such as demographic, socioeconomic status and medical resource affect the incidence of ESRD.
Result: The result has shown that the incidence of ESRD demonstrated a spatial clustering pattern. High incidence of ESRD mainly occurred in central and southern mountain townships. Since the start of the segment in 2002-2004, the clustering area began to appear in central and southern coastal areas. Not only has the area of medical resources and demographic factors but existed neighborhood effect influence the incidence of ESRD.
Conclusion: These results will help policies to practice, in addition to improving the health status of regions, the spillover effects can also enhance the effectiveness of policy implementation.
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