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題名：從「購買醫療服務」到「購買健康」？--氣喘醫療服務改善方案的經濟面評估與病人滿意度調查
書刊名：臺灣社會福利學刊
作者：翁慧卿
作者(外文)：Weng, Hui-ching
出版日期：2004
卷期：3:2
頁次：頁37-78
主題關鍵詞：氣喘；醫療服務改善方案；疾病管理；論質計酬；全民健康保險；Asthma；Disease management；Pay by quality；National health insurance
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中央健康保險局於201年11月提出「購買健康」為導向的新理念，推行氣喘等五大疾病的醫療服務改善方案（又稱疾病管理論質計酬方案）。本研究主要探討加入疾病管理試辦計畫的病人在經濟面的改弈。本研究計設計使用健保局的次級資料及病人問卷的初級資料來分析。實驗組之氣喘病人計22,642人，全國對照組病人為551,902。完成年終照護者共1067人，本研究選取完成一年年終照護之舊個案氣喘病人854位進行實驗組前後測醫療費用的檢定，及醫療服務滿意度的調查。共蒐集病人問卷671份。氣喘疾病管理的成效在一年介入後，已有初步正面的效果顯現。醫療資源改變上，第二年較第一年顯著增加的有門診次數(26.1%)、門診費用(41.8%)、總次數(23.4%)與總費用(26.5%)。顯著降低的有急診次數(-34.4%)、急診費用(-31.2%)與住院天數(-35.8%)。住院次數(-11.2%)與住院費用(-25.1%)雖在統計上沒有呈現顯差異，但已有大幅降低的趨勢。有七成以上的病人滿意氣喘的照護、八成以上的病人同意接受治療後，氣喘控制比以前好。
The objective of this study was to investigate the effect of an outpatient-based healthcare quality improvement program for patients with asthma. Using a population-based approach and prospective perspective, total costs and number of vests per member for medical services 1 year before and after entry into this disease management program for enrolled participants were compared during the fiscal year 200, 11 to 2003, 9. Patients who were diagnosed with asthma at least 1 year prior to the implementation of the program were included; all patients were members of Bureau of National Health Insurance in Taiwan. Of the 570,739 patients with asthma, 22,642 (3.97%) patients who were participated this program served as an experimental group. Because of difference time of patient enrollment to this program and high dropout rates (77.34%), only 854 patients completed 1-year follow-up program by 2003,9. The total mean number of visits increased form 11.526 to 14.220 at follow-up. Though the total mean costs (26.5%) and outpatient costs (26.1%) increased, the mean emergency department (ED) visits and hospitalization rates were significantly reduced by 34.4% and 51.74%, respectively, compared to the previous year. The4se findings would be expected if outcome-based disease management were effectively promoting clinically indicated outpatient interventions, thereby avoiding complications that resulted in inpatient admissions and ED utilization as well as higher costs. These results have significance for the design of future programs in the Bureau of National Health Insurance, TAIWAN aimed at improving the care of people with asthma and other chronic diseases.
期刊論文
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2.Thoonen, B. P. A.、Schermer, T. R. J.、van den Boom, G.、Molema, J.、Folgering, H.、Akkermans, R. P.、Grol, R.、van Weel, C.、van Schayck, C. P.(2003)。Self-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial。Thorax，58(1)，30-36。  new window
3.Juniper, E. F.、Guyatt, G. H.、Ferrie, P. J.、Griffith, L. E.(1993)。Measuring quality of life in asthma。The American review of respiratory disease，147(4)，832-838。  new window
4.謝貴雄(19951100)。小兒氣喘病之預防和處理。中華民國小兒科醫學會雜誌，36(增刊B)，9-20。  延伸查詢new window
5.黃三桂、王悅萍、錢慶文(20020600)。疾病管理對糖尿病患醫療資源耗用之影響。醫務管理期刊，3(2)，35-48。new window  延伸查詢new window
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7.吳家興、林瑞雄、謝貴雄、邱文達、陳麗美、邱淑媞(19980601)。台灣北部國中學生氣喘盛行率調查。中華公共衛生雜誌，17(3)，214-225。new window  延伸查詢new window
8.Guendelman, S.、Meade, K.、Benson, M.、Chen, Y. Q.、Samuels, S.(2002)。Improving asthma outcomes and self-management behaviors of inner-city children: a randomized trial of the health buddy interactive device and an asthma diary。Archives of Pediatrics & Adolescent Medicine，156，114-102。  new window
9.中央健康保險局(2002)。從「為全民購買健康」談全民健保五項疾病醫療給付改善方案--為民眾買到健康的健保新理念。全民健康保險雙月刊，35，20-22。  延伸查詢new window
10.中央健康保險局(2003)。提供整體性醫療照顧、提升醫療服務品質--健保為慢性病患打造全方位的照護網。全民健康保險雙月刊，41，15-16。  延伸查詢new window
11.Adams, R. J.、Fuhlbrigge, A.、Guilbert, T.、Lozano, P.、Martinez, F.(2002)。Inadequate Use of Asthma Medication in the United States: Results of the Asthma in America National Population Survey。Journal of Allergy & Clinical Immunology，110，58-64。  new window
12.Allen-Ramey, F. C.、Diette, G. B.、McDonald, R. C.、Skinner, E.A.、Steinwachs, D. M.、Wu, A.W.(2002)。Methods Aimed at Improving Asthma Care and Outcomes Management: A Case Study。Disease Management Health Outcomes，10，495-503。  new window
13.Battleman, D. S.、Callahan, M. A.、Silber, S.、Munoz, C. I.、Santiago, L.、Abularrage, L.、Jabbar, H.(2001)。Dedicated Asthma Center improves the Quality of Care and Resource Utilization for Pediatric Asthma: A Multicenter Study。Academic Emergency Medicines，8，709-715。  new window
14.Berg, G. D.、Johnson, A.、Fleegler, S.(2003)。Clinical and Utilization Outcomes for a Pediatric and Adolescent Telephonic Asthma Care Support Program: A Propensity Score-Matched Cohort Study。Disease Management Health Outcomes，11，737-743。  new window
15.Boednheimer, T.(2000)。Disease Management in the American Marker。British Medical Journal，320，536-566。  new window
16.Chan, D. S.、Callahan, C. W.、Moreno, C.(2001)。Multidisciplinary Education and Management Program for Children with Asthma。American Journal of Health System Pharmacy，58，1413-1417。  new window
17.Disease Management American Association(20010219)。DMAA News Letter。  new window
18.Ebbinghaus, S.、Bahrainwala, A. H.(2003)。Asthma Management by an Inpatient Asthma Care Team。Pediatric Nursing，29，193-194。  new window
19.Groban, M. D.、Evans, R. M.、Edgren, B.、Butt, L. T.、Stefano, A. D.、Feranndes, D. J.、Buchner, D. A.(1998)。Clinical Benefits and Cost Reduction Associated with a Comprehensive Asthma Management Program at a Managed Care Organization。Disease Management and Health Outcomes，4，93-100。  new window
20.Kauppinen, R.、Vilkka, V.、Sintonen, H.(2001)。Long-Term Economic Evaluation of Intensive Patient Education During the First Treatment Year in Newly Diagnosed adult Asthma。Respiratory Medicine，95，56-63。  new window
21.Kelly, C. S.、Morrow, A. L.、Shults, S.、Nakas, N.、Strop, G. L.、Adelman, R. D.(2000)。Outcomes Evaluation of a Comprehensive Intervention Program for Asthmatic Children Enrolled in Medicaid。Pediatrics，105，1029-1035。  new window
22.Kelso, Tm.、Self, T. H.、Rumbak, M. J.、Stephens, M. A.、Garrett, W.、Arheart, L.(1995)。Educational and Long-Term Therapeutic Intervention in the ED: Effect on Outcomes in adult Indigent Minority Asthmatics。American Journal Emergency Medicine，13，632-637。  new window
23.Lai, C. K.、De Guia, T. S.、Kim, Y. Y.、Kuo, S. H.、Mukhopadhyay, A.、Soriano, J. R.、Zainudin, N.、Zhong, N. S.、Trung, P. L.、Zainudin, B. M.(2003)。Asthma Insights and Reality in Asia-Pacific Steering Committee. Asthma Control in the Asia-Pacific Region: the Asthma Insights and Reality in Asia-Pacific Study。Journal of Allergy & Clinical Immunology，111，263-268。  new window
24.Love, M. M.、Mainous, A. G.、Talbert, J. C.、Hager, G. L.(2000)。Continuity of Care and the Physician-Patient Relationship: The importance of Continuity for adult Patients with Asthma。Journal of Family Practice，49，998-1004。  new window
25.Lukacs, S. L.、France, E. K.、Baron, A. E.、Crane, L. A.(2002)。Effectiveness of an Asthma Management Program for Pediatric Members of a Large Health Maintenance Organization。Archive of Pediatric and Adolescence Medicine，156，872-876。  new window
26.Madge, P.、McColl, J.、Paton, J.(1997)。Impact of a Nurse-Led Home Management Training Programme in Children Admitted to Hospital with Acute Asthma: A Randomized Controlled Study。Thorax，52，223-228。  new window
27.Marabini, A.、Brugnami, U.、Curradi, F.、Casciola, G.、Stopponi, R.、Pettinari, L.、Siracusa, A.(2002)。Short-Term Effectiveness of an Asthma Educational Program: Results of a Randomized Controlled Trial。Respiratory Medicine，96，993-998。  new window
28.Markson, L. E.、Vollmer, W. M.、Fitterman, L.、O’Connor, E.、Narayanan, S.、Berger, M.、Buist, A. S.(2001)。Insight into Patient Dissatisfaction with Asthma Treatment。Archive of Internal Medicine，161，379-384。  new window
29.Marosi, A.、Stiesmeyer, J.(2001)。Improving Pediatric Asthma Patient Outcomes by Incorporation of Effective Interventions。Journal of Asthma，38，681-690。  new window
30.Rabe, K.F.、Vermeire, P. A.、Soriano, J. B.、Maier, W. C.(2000)。Clinical Management of Asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) Study。European Respiratory Journal，16，802-807。  new window
31.Radzwill, M. A.(2001)。Integration of Case and Disease Management- Why and How?。Disease Management and Health Outcomes，10，277-289。  new window
32.Ronchetti, R.、Indinnimeo, L.、Bonci, E.、Corrias, A.、Evans, D.、Hinid-Alexander, M.、Midulla, F.、Pulejo, R.、Villa, M. P.(1997)。Italian Study Group on Asthma Self-Management Programs: Asthma Self-Management Programs in a Population of Italian Children: A Multicentric Study。European Respiratory Journal，10，1248-1253。  new window
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34.Sidorov, J.、Shull, R.、Tomcavage, J.、Girolami, S.、Lawton, N.、Harris, R.(2002)。Does Diabetes Disease Management Save Money and Improve Outcomes? A Report of Simultaneous Short-Term Savings and Quality Improvement Associated with a Health Maintenance Organization-Sponsored Disease Management Program among Patients Fulfilling Hea。Diabetes Care，25，684-689。  new window
35.Skledar, S. J.、Hess, M. M.(2000)。Implementation of a Drug-use and Disease-State Management Program。American Journal of Health System Pharmacy，57(4)，23-299。  new window
36.Steinbrook, R.(1998)。Patients with Multiple Chronic Conditions-How Many Medications Are Enough?。The England Journal of Medicine，338，1541-1542。  new window
37.Stevens, C.、Wesseldine, L.、Couriel, J.、Dyer, A.(2002)。Parental Education and Guided Self-Management of Asthma and Wheezing in the Pre-School Child: A Randomized Controlled tria。Thorax，57，39-44。  new window
38.Suh, D.、Shin, S.、Voytovich, R.(2000)。A Economic Impact of an Asthma Education Programme on Medical Care Utilization。Disease Management Health Outcomes，8，159-170。  new window
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研究報告
1.蔡文正(2003)。全民健康保險肺結核病患醫療改善方案試辦計畫之評估 (計畫編號：DOH91-NH-1020)。台北市。  延伸查詢new window
2.李玉春(2003)。建立全民健保以以同照護模式為基礎的糖尿病疾病管理計畫先導性研究（第三年） (計畫編號：DOH91-NH-1002)。  延伸查詢new window
圖書
1.葉金川(2003)。全民健保傳奇。臺北市：董氏基金會。  延伸查詢new window
2.National Institutes of Health, National Heart, Lung, and Blood Institute: Global initiative for asthma(2002)。Global strategy for asthma management and prevention。National institutes of health, national heart, lung, and blood institute。  new window
3.Tabachnick, B. G.、Fidell, L. S.(2001)。Using multivariate statistics。Boston：Allyn and Bacon Boston。  new window
4.中央健康保險局(2001)。全民健康保險氣喘醫療服務改善方案。台北：衛生署。  延伸查詢new window
5.行政院衛生署(2001)。氣喘診斷指引。台北：衛生署。  延伸查詢new window
6.吳錦松、黃五美、吳淑女、賴啟安、林煒傑(2002)。健保局南區分局實肺結核疾病管理之研討。台北：中央健保局南區分局。  延伸查詢new window
7.黃達夫(2001)。用心，在對的地方。台北：天下文化。  延伸查詢new window
8.Department of Health, the Executive Yuan(2003)。Health and Vital Statistics Republic of China, 1981-2002。Taipei。  new window
9.Jefferson, T.、Demicheli, V.、Mugford, M.(2000)。Elementary Economic Evaluation in Health Care。London：BMJ。  new window
其他
1.Wolf, Fredric M.，Guevara, James P.，Grum, Cyril M.，Clark, Noreen M.，Cates, Christopher J.(2002)。Educational Interventions for Asthma in Children。  new window
2.Price, I.(2000)。Determining if Skewness and Kurtosis Are Significantly Non-normal，htty ://une.edu. au/webstat/unit_materials/c4_descriptive_statistices/determine_skew_kurt， 2004/09/09。  new window
 
 
 
 
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