台灣未成年人口外在事故住院之醫療資源耗用與預測因子

Medical Utilization and Predictors of Hospitalized Children Caused by Injure or Poisoning in Taiwan

本文在於分析台灣18歲以下未成年族群因外在事故住院所造成的醫療資源耗用差異，並探討病患及就醫特質對醫療資源耗用之影響，所採用的資料來源為國家衛生研究院建置的96-98年健保住院醫療費用清單明細抽樣檔，擷取診斷欄位外因分類分類碼為E800~E999且為第一次住院病患樣本58,404人進行分析。本文研究對象以傷害類型、病患及就醫特質區分，並作為預測醫療資源耗用的變因。醫療資源耗用則包含手術處置、住院天數及醫療費用，除分別與病患特質、就醫特質和傷害特質各變因進行差異分析外，也使用羅吉斯迴歸分析各因子調整後勝算比（adjusted odds ratio; AOR），探討手術處置、高住院天數與高醫療費用之影響因子。發現研究對象平均住院天數為3.5天、醫療費用為20,839元，接受手術處置者佔73% （42462人）。交通事故（35.7%）是最主要住院原因，雖然來自於醫療過失所造成的住院病患不多，但其卻是導致最高醫療資源耗用的原因，三項醫療耗用勝算比（AOR）為其他傷害2倍以上。疾病複雜度雖然不致於增加病患手術的可能性，但卻會增加高住院天數的可能性（AOR=1.9-3.8）。男性病患有較低的住院天數，但其手術與高醫療費用風險卻比女性來得高，且15-17歲青少年族群是未成年人口中醫療耗費最高者。相對於東部，南部醫院有較高的手術比例（AOR=1.4-1.6），東區醫院則有最長之住院天數風險，然而醫療費用卻相對較低；研究也發現高醫院層級及高住院次數與高醫療耗用風險有關。因此，本研究結果可增加對影響外在事故醫療耗用因素之了解，可提供醫療或衛生主管機構在未來醫療資源評估與分配之參考。

The aim of this study was to analysis the inpatient medical utilizations and their associated factors among children under age 18 who caused by injure or poisoning. The study subjects were consisted of 58404 infants, children and adolescent caused by injure or poisoning discharged from the hospital between 2007 and 2009. Demographic characteristics, external cause diagnoses and medical utilization were retrieved from the inpatient claim data of the National Health Insurance Database. With surgery, length of stay (LOS) and medical cost as outcomes, the differences of characteristics of accidents, patients and hospitals on the medical utilization were analyzed. Further, the risks of factors associated with the high medical utilization were estimated using a logistic regression approach and adjusted odds ratio (AOR). Of those study subjects, mean 3.5 days LOS and 20839 NT dollars of medical cost were observed. 73% (42462) inpatients were administrated with surgery. Traffic accidence occupied most proportion (35.7%) for cause of hospitalization. Though less inpatients, hospitalization caused by misadventure during medical care was the most critical cause which results in the highest medical utilization. Higher complication or co-morbidity could not increase the risk of surgery, but it raised risk on high LOS (AOR=1.9-3.8). Boys had lower risk on high LOS and higher risk on high cost. The adolescence aged 15-17 cost the highest utilization while comparing to the other age groups. Comparing with eastern, the hospitals located in southern Taiwan had higher risk on surgery (AOR=1.4-1.6). Nonetheless, hospitals in eastern had longest LOS and lowest medical cost. Moreover, higher accreditation also contributed more medical utilization. Our finding elucidates the factors associated with medical utilization, which provide an evidence for health authorities while a medical resource needs to be estimated or distributed.