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    政大機構典藏 > 商學院 > 統計學系 > 學位論文 >  Item 140.119/122255
    Please use this identifier to cite or link to this item: http://nccur.lib.nccu.edu.tw/handle/140.119/122255

    Title: 以全民健保資料庫探討癌症之醫療服務利用
    Using National Health Insurance Database to Explore Medical Usage of Cancer Patients
    Authors: 楊佩雯
    Yang, Pei-Wen
    Contributors: 余清祥

    Yang, Pei-Wen
    Keywords: 全民健保
    National Health Insurance Database
    Big data
    Medical need
    Population aging
    Date: 2018
    Issue Date: 2019-02-12 15:41:01 (UTC+8)
    Abstract: 重大傷病為健保資料庫的主要特色之一,持有重大傷病卡之患者可免除部 分負擔,減輕罹患重病患者的醫療負擔,達到以社會保險的形式分攤弱勢團體 的就醫需求。截至 106 年 10 月,衛福部核發有效領證人數已達 90 萬 191 人 (約 4%人口),其中重大傷病約有 10%人口擁有複數個重大傷病,衛福部紀錄 重大傷病患者之重大傷病相關醫療費用佔全體 27%,若再加上非重大傷病就醫 費用,支出比例更可達 33%。由於重大傷病的發生率隨年齡而上升,其中患者 的死亡機率也逐年下降,預期重大傷病患者的人數及其醫療利用會隨著人口老 化而增加。
    本文使用健保資料庫探討癌症病患罹患重大傷病前後的醫療服務利用之差 異,希冀研究結果可用於提早發現癌症,除了以預防勝於治療增進國人健康, 更可有效控制健保支出。透過重大傷病證明明細檔(HV)、重大傷病門診處方 及治療明細檔(HV_CD),利用大數據分析方法探討國人罹患癌症的特性,從 盛行率、發生率、死亡率、存活率出發,探討國人罹患癌症之醫療服務利用, 如醫療費用、就醫次數、非重大傷病就醫、單張卡及複數卡的醫療利用等,本 文進而探討癌症病患罹患重大傷病前後的醫療服務利用之差異。研究發現近年 來癌症發生率逐年上升,而癌症死亡率逐漸下降的趨勢;而癌症病患在領卡前 後為就診高峰,且在領卡前其就診次數就高於一般人;另外也發現第一張重大 傷病卡為癌症,第二張重大傷病卡為另外一種癌症的比例最高。
    Catastrophic illness (CI) is one of the main features in National Health Insurance (NHI) Database. People with CI card can enjoy waiver of copayment and other medical benefits which reduce the financial burden of CI patients. As of October 2017, Ministry of Health and Welfare calculated that 900 thousand people has CI card, it means about 4% Taiwan’s population were with the CI card and they spend more than 27% of total medical expenditure of NHI. Since the probability with CI increases with age and decrease with death rate, the population aging and prolonging life are expected to worsen the financial burden of the NHI.
    We use NHI database to explore the difference of medical need with cancer patients before and after they got CI card. Hope the results can be used for early detection of cancer. In addition to prevention, it can efficiently control the expenditures of NHI. We analysis the feature of cancer patients by using the data from the NHI Database, including Registry for catastrophic illness patients (HV) and HV’s Ambulatory care expenditures by visits (HV_CD). We calculated prevalence rate, incidence rate, death rate and survival rate, and explore the medical need of cancer patients, and then explore the difference of medical need with cancer patients before and after they got CI card. We found that cancer incidence rate is increasing and cancer death rate is decreasing year by year. The cancer patients have a peak of medical treatments before getting CI cards, and cancer patients’ number of medical treatment before getting CI cards was higher than the average person. If cancer patients got the first CI card that was cancer card, and there was high probability to get another cancer card.
    Reference: 一、 中文部分
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    2、 行政院衛生福利部(2018),癌症登記年度報告。
    3、 行政院衛生福利部(2018),死因統計。
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    8、 連賢明(2011),如何使用健保資料推估社經變數? 《人文及社會科學集 刊》,23,371-398。
    9、 陳昱霈(2016),全民健保資料庫分析:以全民健康保險資料庫探討癌症的 發生與死亡,國立政治大學商學院統計學系碩士論文。
    10、 陳建仁、林莉華(1997),健康保險資料庫之學術應用:重大傷病證明資 料檔分析之經驗,中華公共衛生雜誌 ; 16 卷 6 期。
    11、 張鴻仁、黃信忠、蔣翠蘋(2002),全民健保醫療利用集中狀況及高、低 使用者特性之探討,台灣公共衛生雜誌;21 卷 3 期。
    12、 黃泓智、劉明昌、余清祥(2004),台灣地區重大傷病醫療費用推估,人 口學刊;29,35-70。
    13、 蔡秉諺(2010),台灣慢性腎臟疾病患者盛行率與醫療利用分析-以健保資 料庫為例,臺北醫學大學醫務管理學研究所學位論文。
    14、 蔡偉德、陳芝嘉、余清祥(2014),“老人醫療利用的價格效果-以 921 震災 的自然實驗為例”, 經濟論文 (TSSCI), vol. 42(4), 599-645.。
    15、 劉介宇、劉滄梧、劉季鑫、蕭金福、陳立宗(2009),2001 年至 2003 年 台灣五大盛行癌症(肺癌,肝癌,大腸直腸癌,胃癌,女性乳癌)全民健保給 付之探究,中華民國癌症醫學會雜誌 ; 25 卷 3 期。
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    二、 英文部分
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    Description: 碩士
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0105354005
    Data Type: thesis
    DOI: 10.6814/THE.NCCU.STAT.001.2019.B03
    Appears in Collections:[統計學系] 學位論文

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