健保氣喘試辦計畫會改善醫療品質嗎？

Will the asthma disease management improve the medical quality and expenditure?

中央健康保險局於2001年11月起推動「氣喘醫療給付改善方案試辦計畫」，透過支付制度的改善，期望達到提升氣喘患者之照護能力及改善生活品質之目的，長期實施後更盼能降低整體醫療費用。本研究以6-12歲之兒童為主要研究對象，應用2004至2006年台灣全民健康保險醫療費用申報檔進行回溯性資料分析，並進行實驗組與對照組之DID比較，了解醫療耗用趨勢，檢視「氣喘醫療給付改善方案試辦計畫」介入前後，門診照護對於急診及住院醫療資源耗用情形的相關影響。在控制其他變項後，氣喘試辦計畫的介入效應為：平均門診總次數增加1.67次，平均門診總費用為0.08倍；平均急診總次數下降0.11次，平均急診總費用為0.56倍；平均住院總次數減少0.001次、平均住院總費用為1.04倍、平均住院總天數增加0.01天；在平均年度醫療總費用上則為0.08倍。「氣喘醫療給付改善方案試辦計畫」的介入對於兒童在醫療資源使用的影響如下：門診總次數上升，但門診總費用下降；急診總次數、急診總費用皆呈現下降的趨勢；住院總次數減少，住院總費用上升，但住院天數沒有達到顯著意義；在整體醫療總費用上，呈現下降的趨勢。由於此試辦計畫主要目的為加強病患自我照護的能力，減少急症及併發症的發生，從研究結果來看對於兒童氣喘急症發作確有達到良好的控制。

“An Asthma Pay-for-Performance Demonstration Project on Treatment” (referred to AP) has been implemented by the Bureau of National Health Insurance (BNHI) since November 2001, however the outcome of this project has rarely been evaluated through data nationwide. The main purpose of this study is to assess the true effect in medical utilization of this project through randomly selected national samples. Difference-in-difference (DID) comparisons of the experimental and control groups, in utilization were used to find out the true outcome of the AP. After controlling some variables, the AP had the following effects: total outpatient visits increased by 1.67 time, total outpatient fee grew by 0.08 time per child, number of emergencies decreased by 0.11 time, total emergency expense grew by 0.56 time, frequency of hospitalization decreased by 0.001 time, total inpatient expense increased by1.04 time, total inpatient days increased by 0.01day, and total medical expense grew by 0.08 time. The main purpose of AP is to improve the patients’ self care abilities and to reduce the emergency and complications to occur; children’s asthma break outs may well be controlled according to the result. Therefore it is recommended that the government build up a mutual care taking website, to enhance the complete tracking rate; to implement disease management and asthma education, decrease emergency break outs, also to reward and encourage hospitals that have met the quality monitoring targets, in the end effectively decrease the emergency treatments and hospitalization in the long term.