| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 100 === Background and Importance
Incidence and prevalence of End Stage Renal Disease (ESRD) in Taiwan has been the top of world for several years. Healthcare and financial issues of dialysis patients have become a heavy burden both in society and economics. In order to minimize the health expenditure by improving the quality of dialysis, the Bureau of National Health Insurance in Taiwan has implemented the Global Budget System in 2001, and a rewarding project for improving the quality of outpatient dialysis services for chronic renal failure patients. This study aims to review the healthcare pattern of dialysis patients and to evaluate its effects on health expenditure and health status. It is expected to provide the reference information for the government to regulate health care procedure and to establish payment and control system of health expenditure in the future.
Methods
This study utilizes National Health Insurance Research Database (NHIRD) to select the patients from July 1st, 2003 to June 30th, 2004 who underwent their first dialysis for at least 6 months. Difference in differences (DID) and Generalized Estimating Equation (GEE) models are used in this study to control confounding factors and individual differences. Health expenditure and health status of the objects are reviewed for one year period before and after the transfer of dialysis care institution.
Results
In this study, 34.93% of dialysis patients are non-fixed care patients, and among them, most are female and with diabetes, congestive heart failure and atherosclerosis heart disease. Overall, health status of non-fixed care patients is increasing in severe degree than fixed care patients, as well as their health expenditure in outpatient clinics. But health expenditure in inpatient is relatively restrained in increasing.
The objects are divided into groups according to their healthcare transfer patterns. Except there is no difference in inpatient expenditure of dialysis patients transferred from high level to low level institution, all the other transfer patterns are relatively restrained. For healthcare utilization, non-fixed care patterns have positive association with increase of outpatient utilization, however, inpatient utilization are relatively restrained. For health status, patients’ transfer in same level and from low level to high level have significant differences in burden of morbidity, but there is no significant association in transfer from high level to low level.
Conclusion and Suggestions
Overall, the health status of non-fixed care patients becomes poor and outpatient expenditure is also increased. Although, inpatient expenditure is relatively restrained, poor health status has brought adverse impact on management of healthcare resources and patients’ health. For group of transfer from high level to low level, outpatient expenditure is higher than fixed care patients, and there is no significant association on inpatient expenditure. This reveals that management of low level institutions still need to improve. The health status of groups of transfer in same level and from low level to high level have also become poor, and have disadvantage on patients’ health management. Inpatient health expenditure of non-fixed care patients are all decreased, and this reveals that fixed care institutions still have to improve their management on inpatient health expenditure.
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