中醫小兒氣喘試辦計畫成效分析與未來發展

Effectiveness Analysis of Chinese Medicine Pediatric Asthma Trial Project and Future Development

動機及目的：氣喘盛行率速增加使醫療耗用上漲，本研究將針對「小兒氣喘緩解期中醫優質門診照護試辦計畫」，探討參加中醫小兒氣喘試辦計畫在醫療資源利用上之效益。 研究方法：以參加試辦計畫患童為實驗組，未參加任何氣喘試辦計畫且就醫特質相近患童為對照組。資料來源為國家衛生研究院提供2005至2007年之健保申報資料檔，實驗組共計128人，對照組則以實驗組性別、年齡交叉分佈分析後篩選128人。 研究結果：實驗組參與計畫後，住、急診醫療次數與費用均下降，門診及醫療總費用部分，若是2007年含試辦計畫次數與費用，不論實驗組與對照組均為增加，但若不含試辦計畫次數與費用時，實驗組降低但對照組增加，且有顯著差異。 結論與建議：實施氣喘疾病管理後，減少急、住診次數與費用，且參加者醫療總費用少於未參加者，確實達到降低急性氣喘發作的頻率與嚴重度及成功管控醫療費用之目的，而醫療院所也增加額外獎勵收入。建議醫院管理者積極參與，及早適應並規劃其運作模式；衛生主管機關可擴大適用範圍，訂定回饋指標及獎懲規範，避免醫療院所偏重爭取給付，而忽略醫療品質與病患就醫權益。

Purpose: Elevating asthma prevalence rate increases health care consumption, this article aims at '' high-quality Chinese medicine outpatient care pilot program for Pediatric asthma remission '' to explore the benefits of Chinese Pediatric asthma pilot programs in medical resource utilization. Methods: Based on “National Health Insurance Research Database”, 128 participators included in experimental group who were enrolled in the data base from 2005 to 2007 and compared with 128 non-participators. There are no significant differences in gender and age distributions between experimental group (participators) and control group (non-participators). Results: After the experimental group participating the pilot program, there were decreased both frequency and cost of hospitalization and emergency service. In 2007, comparing the total fee of out-patient clinic and health care, both the experimental group consume the pilot program medical treatments and costs and the control group consume conventional treatment costs are generally increasing. If neglecting the fee of pilot program, the experimental group consuming costs reduced but the control group increased with a significant difference statistically. Conclusions and suggestions: Implementing the asthma disease management, it was reduced the medical treatments and fee of hospitalization and emergency service. The total health care costs of participants was less than who was not participated. Indeed, to reduce the frequency of acute asthma attacks and severity of medical costs and purpose of controlling medical treatment fee successfully. The health care institutions get additional incentive income also. Propose hospital administrators actively participate, adapt its mode of operation early. The health authorities expands the scope of set back norms of indicators and rewards and punishments, to avoid payment of medical institutions for emphasis, while ignoring the quality of care and patient medical interests.