| Summary: | 碩士 === 淡江大學 === 保險學系保險經營碩士在職專班 === 106 === The top ten causes of cancer have been ranked first for many years in Taiwan, leading to cancer insurance has become one of the mandatory policies for each person.In 2013,the ealth insurance system was changed to the DRGs system.Therefore, hospitalization standards have become stricter than in the past.Under this premise,the Cancer Chinese Medicine Clinic has become a new option for cancer insurance insured, and it has become a huge burden on the out-of-pocket expenses of cancer insurance.There are mostly convalescent and non-essential treatments of the Chinese medicine clinics.This is inconsistent with the concept of outpatient treatment for cancer diseases in the cancer insurance clause agreement.Therefore,the insurance company will have a specific cooperation of Chinese medicine practitioners to provide professional insights in order to avoid over-claims for cancer insurance in Chinese medicine clinics.
The main purpose of this study can be summarized as follows:
1. This study gathers medical consultation information for existing cancer clinics in Chinese medicine.The study analyzed the variables that affect Chinese medicine doctors'' judgment on the conditions of traditional Chinese medicine for cancer clinics, and explore the relationship between the variables and the number of payments.
2. This study cross-analyzed the background of the insured and in-depth interviews with experts to analyze which variables were relevant to Chinese medicine practitioners in judging the outpatient clinic for cancer and the number of reasonable payments.This study summarized the medical consultation information of a life insurance company''s Cancer Chinese Medicine Clinic from 2013 to 2017.Through narrative statistical analysis, cross-analysis, chi-square test and conduct in-depth expert interviews to understand the relationship between variables, the final findings are as follows:
(1)A total of 42.8% of Chinese Medicine physicians will reply to the proposal for all payments in the case of the company’s.
(2)The primary factor is whether the client receives radiotherapy and chemotherapy within five years,and the secondary factor is whether or not he has cancer within five years.This is the main variable that affects the number of responses to Traditional Chinese Medicine physicians.
(3)It does not affect the number of Chinese doctors’ suggestions on whether or not to use special Chinese medicines.
(4)Western medicine is mainly supplemented by traditional Chinese Medicine, it is a complete course of treatment for cancer.
In the future,when faced with a case of similar Chinese cancer clinics,the results of this study can be used to determine the reasonableness of the claims and the number of claims,thereby reducing the cost of medical consultation for traditional Chinese medicine in cancer clinics.
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