遠距健康照護對可避免住院與醫療利用之影響

The effect of tele-healthcare intervention on preventable hospitalizations and healthcare utilization in Taiwan

目標：本研究旨在探討遠距健康照護能否減少可避免住院及抑制醫療費用成長？方法：研究對象為中部某醫院遠距健康照護計畫「銀髮族U-Care計劃」之收案個案（實驗組）以及該地區未參與計畫的居民（對照組）。我們以傾向分數配對模型自健保資料庫2009-2011年的醫療利用檔擷取對照組，以住院總次數的成長平均數為中點，區分「高醫療利用成長」與「低醫療利用成長」兩族群，再以差異中取差異迴歸探討遠距健康照護對可避免住院與醫療利用之影響。結果：遠距健康照護使得高醫療利用成長族群的門診次數增加約2次、可避免住院次數減少0.052次，每次住院費用、每次門診費用與門診住院總費用分別約減少8,743、225與15,917點；遠距健康照護使得低醫療利用成長族群住院總次數減少0.036次、門診次數增加約1次。結論：遠距健康照護對高醫療利用成長族群的可避免住院次數與醫療利用有顯著的抑制效果。然而，研究個案參與此計畫無須支付任何費用，對於遠距健康照護有助於健保財務管理的正向效益推論仍須持著謹慎保留的態度。

Objectives: The aim of this study was to investigate whether tel-healthcare intervention could reduce preventable hospitalizations and healthcare expenditures. Methods: The case group was made up of those who participated in the Senior U-Care program (a tel-healthcare intervention) administrated by a hospital in central Taiwan. We utilized the Propensity Score Matching model to create a control group from the National Health Insurance Research Database over the period from 2009 to 2011. All patients in both groups were divided into high growth utilization and low growth utilization groups based on the mean growth in the total number of hospital admissions. The difference-in-differences model was used to investigate the impact of the tel-healthcare intervention on preventable hospitalizations and healthcare utilization. Results: The tel-healthcare intervention increased outpatient visits by approximately 2 but decreased preventable hospital admissions by 0.052 in the high growth utilization group. Additionally, inpatient expenditure (per admission), outpatient expenditure (per visit), and total healthcare expenditure in the high growth utilization group decreased by 8,743, 225, and 15,917 point values respectively due to the tel-healthcare intervention. The tel-healthcare intervention decreased approximately 0.036 inpatient admissions but it increased 1 outpatient visit for the low growth utilization group. Conclusions: Tel-healthcare intervention effectively decreased preventable hospitalization and healthcare expenditures in the high growth utilization group. Nevertheless, the services provided by the tel-healthcare intervention under study were free of charge to participants. We should therefore be cautious about concluding that tel-healthcare intervention would generate a positive effect on the financial management of the national insurance system.