低價值醫療：國際經驗與對台灣的啟示

Low-value healthcare: international development experiences and the inspiration for Taiwan

據經濟合作暨發展組織（OECD）統計，世界各國醫療費用皆有穩定上升的趨勢，為解決財務短絀，健康照護資源之重分配儼然成為政府必須面對的課題，而減少低價值醫療的使用，不僅能夠降低非必要的醫療保健支出，更可同時確保健康照護品質之水準。本文自PubMed及Web of Science等資料庫中進行文獻搜索，最後納入28篇具有量化分析之文獻進行綜合回顧。近年來歐美各國持續提出臨床上不建議執行醫療清單，透過彙整國際上低價值醫療之發展沿革、利用情形以及政策介入效益等資訊，能有助於我國政府在研擬改善低價值醫療項目清單之參佐，除低價值醫療項目定義應符合國情外，具有穩定資料來源以利後續監測也是值得重視的一環，藉由促進醫病溝通、有效率地使用醫療資源，降低低價值醫療利用，以達成「以病人為中心」健康照護理念。（台灣衛誌2021；40(2)：151-165）

Health care spending has been growing steadily. With regard to addressing financial challenges in health care systems, resource reallocation has become a critical issue worldwide. Reducing the use of low-value care can minimize health care expenditure and ensure care quality. The recommendations based on evidence-based medicine, such as the Choosing Wisely lists from the United States and the ''Do Not Do'' prompts from the United Kingdom, have been established. This systematic review has extracted 28 articles with quantitative analysis from PubMed and/ or Web of Science. Understanding the development, utilization of low-value care services and the effectiveness of alternatives from other countries, would help develop country-specific lists and definitions. Furthermore, continual monitoring and stable data source of utilization are also essential. It is expected that promoting patient-doctor communication, efficient health care resource reallocation, and reducing the use of low-value care can make the main goals of patient-centered care achieved. (Taiwan J Public Health. 2021; 40(2): 151-165)