唐氏症患者全民健康健保門診醫療利用趨勢分析

Trends in Ambulatory Care Visits and Expenditures among Persons with Down Syndrome in Taiwan

目的：唐氏症患者因醫藥衛生技術之進步，平均生命隨之延長，而伴隨著年齡增長所產生之疾病亦愈多，對於整個醫療照顧、社會服務體系與他們的家庭產生極大的負擔及挑戰。然而，台灣對於他們的實際醫療利用之相關研究相當缺乏。因此，本研究想藉由分析次級資料，來了解唐氏症患者的醫療利用情形。方法：使用2001-2011 年全民健康保險資料庫，將門診處方及治療明細檔ICD-9編碼主、次診斷編碼為758.0 之個案定義為本研究之樣本，分析門診醫療利用情形、變化趨勢與影響因子。結果：使用健保之唐氏症人數自2001 年的2947 人呈逐年增加至2011 年的3684人。平均年齡亦呈現逐年增加趨勢，自2001 年的15.3±13.8 歲逐年增加至2011 年的20.5±14.1 歲，以18 歲以下居多。平均門診次數與平均年醫療費用男性高於女性；有重大傷病註記或中低收入戶高於一般身分；6 歲以下高於其它年紀。小學(含)以下個案復健科利用逐年增加。結論：本研究發現唐氏症者6歲以下醫療利用遠高於其他年齡層，建議相關單位提供整合性之服務，以減少門診次數，降低照顧者經濟與其他方面之負擔。

This study was an examination of population-based data of ambulatory care visits and associated factors among persons with Down syndrome. The study sample included all national health insurance beneficiaries with Down syndrome, and their ambulatory care records from 2001 to 2011 were collected for the analyses. Furthermore, this study also analyzed data to examine the trends of ambulatory care visits and to determine the related influencing factors of those visits. The results revealed that persons with Down syndrome had significantly more medical care visits than the general population in Taiwan, and age was the major factor contributing to their ambulatory care visits. Preschool children with Down syndrome had the highest frequency of ambulatory care visits, and this frequency increased more than that of any other groups studied from 2001 to 2011. This group of children also used more outpatient rehabilitation services than their counterparts. This study indicates that the health authority should examine the medical care trends of persons with Down syndrome, particularly children, to determine their medical care needs and quality of care.