The Study of Medical Behaviors and Mortality Analysis of Patients with Continuous Prescription for Chronic Diseases

[[abstract]]根據內政部統計處報告，2018年我國65歲以上高齡人口已超過14%，進入高齡社會，且國民健康局2015年「台灣中老年身心社會生活狀況長期追蹤調查」顯示，近九成（87.9％）老人自述曾經醫師診斷至少一項慢性疾病。慢性疾病已經成為現代人健康上最大的隱憂，政府為了增加慢性病患者取藥的便利性，以及降低慢性病患者的經濟負擔，實施慢性處方箋制度。由於慢性病需定期看診、長期服藥控制，才能避免病情惡化，因此領有慢性病處方箋患者可視為積極治療的就醫行為。 本文將慢性病患者分成三種類型，探討其就醫行為及死亡率差異，再比較高齡全體、慢性疾病及領有慢箋患者死亡前的醫療費用點數，利用全民健康保險資料庫2005年百萬抽樣檔，以慢性病患者為對象進行分析。研究發現領有慢性處方箋患者死亡率較全國低，將慢性疾病患者分成三類，發現積極治療型死亡率較間歇治療型高。然而，依疾病分析，發現積極治療型死亡率依舊高於間歇治療型。高齡患者的門診費用點數會因距離死亡時間遠而較低，而領有慢性處方箋患者的費用點數相較其他兩類門診費用點數低；住院費用點數則是死亡前兩個月的費用點數較高，其中領有慢性處方箋患者整體費用點數略高於全體及慢性疾病患者。 According to the statistics of the Ministry of the Interior, in 2018, Taiwan’s 65-year-old population has exceeded 14% and entered the elderly society. The National Health Service’s 2015 “Long-term Follow-up Survey on Physical and Mental Life in Taiwan’s Middle-aged and Old People” shows that nearly 90% (87.9%) the elder was had diagnosed at least one chronic disease. Chronic diseases have become the biggest concern for modern people's health. The government has implemented a chronic prescription system in order to increase the convenience of taking medicines for patients with chronic diseases and reduce the economic burden of patients with chronic diseases. Due to chronic diseases require regular visits and long-term medication control, the disease can be prevented from deteriorating. Therefore, patients with chronic prescriptions can be regarded as active treatment of behavior. In this paper, patients with chronic diseases are divided into three types to explore the differences in their medical behavior and mortality, and then compare the medical expenses of all elderly, chronic patients and chronic prescription patients before death. Using longitudinal health insurance database of 2005 from the National Health Insurance Database to analyze patients with chronic diseases. The study found that the mortality rate of patients with chronic prescriptions was lower than that of the country. The chronic diseases patients were divided into three categories, and found that the active treatment type mortality rate was higher than that of the intermittent treatment type. However, according to disease analysis, it was found that active treatment type mortality was still higher than intermittent treatment. The outpatient cost points of elderly patients will be lower due to the distance from the death time, while the cost points for patients with chronic prescriptions are lower than those for the other two types; the hospitalization expenses are higher in the first two months. The cost of the patients with chronic prescriptions was higher and the cost were slightly higher than those of the overall and chronic diseases