| 中文摘要 |
目標：本研究針對存活機率風險群組進行疾病成本探究，期望提供未來醫療政策及相關研究參考。方法：採回溯性病歷研究藉由研究變項建立預測存活機率風險群組，進而審視各群組未來健保署及增加一個生活品質調整後存活人年（1QALY）所需的醫療資源。結果：直接成本占全民健保醫療保健支出住院給付0.087％，在個人醫療保健支出則高出10倍，間接成本（中位數）占人均GDP12％，每增加一位高風險、中風險、低風險患者，健保署則需支付874,104元、1,420,035元、3,488,272元，而健保DRGs相對權重無法呈現資源耗用程度差異性。結論：整體而言，醫療資源耗用影響與DRGs健保支付制度應考慮診斷碼正確性與疾病嚴重度、共病症概念，而從醫療經濟決策點本研究樣本群組均達世界衛生組織建議成本效益評估標準，亦符合成本效果閾值的經濟性，提供未來研擬成本投入與效用措施評估的參考依據。 |
| 英文摘要 |
Objectives: This study explored the healthcare costs of various risk groups based on surviv-al probability. Our findings can serve as a reference for healthcare policymakers and researchers. Methods: Using a retrospective study of patient records, we identified variables to forecast the probability of survival in risk groups in an effort to analyze the resources required from the Na-tional Health Insurance (NHI) Administration to add one quality-adjusted life year (1QALY) to each group. Results: Direct costs were shown to account for 0.087% of NHI expenditures on hospital care subsidies, and increased 10-fold when reimbursed by private health insurance. Indi-rect costs (median) were shown to account for GDP12% per capita. Each additional high-, mod-erate, or low-risk patient cost the NHI Administration NTD 874,104, NTD 1,420,035 and NTD 3,488,272, respectively. Notably, the relative weights of diagnosis-related groups (DRGs) did not exhibit any differences in the level of resource consumption. Conclusions: Important issues to consider in the consumption of medical resources and NHI spending on DRGs include the accu-racy of diagnostic coding, the severity of illnesses, and co-morbidities. From an economic health-care perspective, the sample groups in this study all met the evaluation criteria for cost-effective-ness recommended by the World Health Organization, and surpassed the economic threshold for cost-effectiveness. Our results can serve as a reference for future assessment of cost input and usage effectiveness. |
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