The Impact of Changes in National Health Insurance Payment Policy on Undergoing Palmar Hyperhidrosis Surgery

• Main Authors: Yung-Hua Lai, 賴詠譁
• Other Authors: 蔡文正
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/46718604799013800140

碩士 === 中國醫藥大學 === 醫務管理學系碩士班 === 100 === Objective: Hyperhidrosis palmaris could seriously affect the quality of life of patients. In spite that operations are regarded as the optimal treatment, the quality of life after the operation is not satisfactory. Aiming at hyperhidrosis palmaris operations, Bureau of National Health Insurance conducted the precertification review policy in 2006. This study tends to understand the effects of such a payment policy on the operation acceptance of hyperhidrosis palmaris and the trend. Moreover, the different impact of the policy on distinct patients and institutes are analyzed. Method: Based on 2000 and 2005 population-based National Health Insurance Research Database, hyperhidrosis palmaris patients with the age above 20 and ICD-9 being 780.8 within 1999-2009 were acquired for the analyses. In addition to descriptive analysis and bivariate analysis, logistic regression with Generalized Estimating Equations (GEE) is further utilized for inferential statistics. Results: Among 4,328 hyperhidrosis palmaris patients, 23.49% of them received the operations. 1,016 patients who accepted the operations, most of them were female (56.50%), aged 20-29 years (62.89%), without catastrophic illness(98.13%), Charlson comorbidity index score being 0 (43.25%), with the premium-based monthly salary below NT$22800 (64.76%), not low-income household (99.7%), and living in the area of Taipei branch (37.3%) with the urbanization degree 2 & 3 (47.05%), their medical treatment in private hospital(42.91%) or district hospitals (35.24%). From GEE, the significant factors in operations include gender, age, policy, comorbidity, branches of Bureaus of National Health Insurance, degree of urbanization, and the accreditation level and the ownership of the hospital. Conclusion: Hyperhidrosis palmaris operations dropped from 37.39% in 2000 to 0.79% in 2006, and the drop was even more obvious after the implementation of the precertification review policy. Personal traits, health conditions, payment policy, and the institutes’ characteristics were considered as the major factors in accepting hyperhidrosis palmaris operations.