探討COVID-19 疫情對內科住院醫療資源耗用影響──以南部某區域醫院為例

The Impact of the “COVID-19” Pandemic on the Consumption of Medical Resources by Medical Inpatients

目的：國際嚴重特殊傳染性肺炎(簡稱COVID-19)造成疫情嚴峻，國內為確保醫療院所醫療量能，推動醫療營運降載。本研究以2019年1月至2021年12月內科之住院案件其疾病形態及醫療資源耗用的變化，呈現COVID-19疫情對內科病患就醫特質及醫療費用變異影響程度，探討疫情對醫療機構營運的影響。
研究方法：本計畫為回溯性研究，採用南部某區域醫院2019年1月~ 2021年12月內科住院案件，以國內疫情分「無疫情」、「疫情輕微」、「疫情嚴峻」三區間，分析內科住院醫療費用在疫情狀態下，整體醫療資源耗用變異。
結果：2019年1月~ 2021年12月內科住院案件25,940件，內科住院案件在國內疫情嚴峻期間，月平均住院人數較無疫情期間下降20%，重大傷病佔率上升4.1%；ANOVA分析顯示「無疫情」，「疫情輕微」，「疫情嚴峻」三組住院案件在醫療耗用具有顯著差異，「疫情嚴峻」期間住院費用分析中總醫療費用，檢查費、治療處置費、藥費之均值皆高於「無疫情」，「疫情輕微」兩區間，p < 0.05。
結論：研究區域醫院內科患者住院醫療耗用變化，可看出COVID-19疫情期間，區域醫院內科住院患者數量雖明顯下降，但因重大傷病就醫治療無減少，使疫情嚴峻期間，重大傷病佔率明顯上升，平均醫療耗用亦高於「無疫情」及「疫情輕微」期間；本次結果與中央健康保險署2021年12月份業務執行報告中趨勢相符，顯示臨床醫療人員需承擔的醫療照護並未隨疫情升溫而減輕。期望本研究結果可呈現其醫療資源耗用情形，提供政府機關及醫療機構作為未來因應大型傳染病時策略規劃之參考。

Purpose: COVID-19 caused a worldwide pandemic. To ensure that domestic medical institutions could continue to function, a responsive measure, reducing patient intake, was introduced.
Methods: This was a retrospective study. Data on the number of admissions and hospitalization expenses in the internal medicine department of a regional hospital in southern Taiwan from January 2019 to December 2021 were collected.
Results: A total of 25,940 cases were admitted to the internal medicine department. During the severe epidemic period, the proportion of serious injury or illness increased by 4.1%. ANOVA revealed significant differences in hospitalization expenses between three periods of the pandemic: the nonepidemic, mild epidemic and severe epidemic periods. Total medical expenses were higher in the severe epidemic period than in the nonepidemic and mild epidemic periods (p < 0.05).
Conclusions: The number of hospitalizations decreased significantly during the pandemic compared with that before the pandemic; however, medical treatment of serious injuries or illnesses remained at the same level before and during the pandemic. Medical expenses were higher in the severe epidemic period than in the nonepidemic and mild epidemic periods. These results are consistent with the trend described in the National Health Insurance Administration’s executive report in December 2021, indicating that the burden on clinical medical staff did not decrease as the pandemic intensified. The study results support the efficient utilization of medical resources and provide a reference for government agencies and medical institutions when responding to future large-scale infectious disease outbreaks.