The Analysis of Medical Behavior Before and After the Catastrophic Illness

[[abstract]]重大傷病為我國全民健康保險的重要特色，領有重大傷病卡的病患可以享有免收部分負擔的權益。根據衛福部統計，全民健保開辦後國人領有重大傷病卡的人數從21萬人，至2017年年底為止成長4倍，人數已高達89萬8,732人。但是從2017所有的健保支出中發現，重大傷病患者的醫療費用接近總支出的27.3%，成為我國醫療費用的重大負擔。周立筠（2017）發現每年重大傷病患者罹病後的就診次數大約30次為非重大傷病患者的2倍。因此如何有效降低國人罹患重大傷病是我國醫療單位必需重視的議題。 本文使用SAS軟體分析健保資料庫2003年至2013年所有領有重大傷病卡患者的資料，區分新舊卡患者，依性別、年齡探討每年重大傷病患者罹病前後的就醫行為差異。由於健保資料庫的檔案相當繁複且雜亂，因此將一一介紹除錯步驟及注意事項。研究發現重大傷病新卡病患的就診次數較舊卡病患多，且隨著年齡增加而越來越高，而舊卡病患的門診費用點數高於點數新卡病患。在住院方面，平均住院天數為10-30天，而重大傷病患者的平均住院次數約介於2-4次之間。不論是全體重大傷病或是個別分析四個癌症疾病，觀察其領卡前就診次數最多的疾病，發現糖尿病、本態性高血壓、一般症候及類脂質代謝疾患均時常名列前茅，且就診次數的比例常是其他疾病的數倍，並且患者領卡後，這些疾病的就診次數比例也在前幾名中，顯示慢性疾病已嚴重影響國人健康，甚至為潛藏之重大傷病病因，值得政府有關單位參考防治。 Catastrophic illness are an key features of National Health Insurance in Taiwan. Patients with catastrophic illness cards can have an rights and interest of cost payment exemptions. According to statistics from the Ministry of Health and Welfare, after the start of the National Health Insurance, the number of people with catastrophic illness cards has grown from 210,000 to 4 times by the end of 2017, and the number has reached 890,73. However, from all the health insurance expenditures in 2017, it was found that the medical costs of patients with catastrophic illness were close to 27.3% of the total expenditure, which has become a primary burden on medical costs in Taiwan. Zhou Lijun (2017) found that the number of medical treatments to patients with catastrophic illness was about 30 times per year, which is twice that of patients who don’t have catastrophic illness. Therefore, how to effectively reduce the suffering of patients with catastrophic illness among Taiwanese is an issue that must be taken seriously by medical units in Taiwan. This paper used SAS software analysis of National Health Insurance database from 2003 to 2013, and distinguish all data of patients with catastrophic illness card, made a distinction between old and new card patients, according to gender, age to explore the difference in medical behavior between before and after the patients with catastrophic illness card. Because the files of the health insurance database are quite complicated and messy, we will introduce the debug steps and some points for attention one by one. The research found that the medical treatments of patients with catastrophic illness new card is more than the old card, and increased with age, while the outpatient cost of the old card patients was higher than that of new card patients. In hospitalization, the average length of hospital stay is 10-30 days, while the average number of hospitalizations for catastrophic illness patients is between 2-4 times. Whether it is a catastrophic illness or analysis of four cancer diseases individual, observe the most number of medical treatments with the disease before having the card, the results show that the proportion of diabetes, essential hypertension, general symptoms, and lipid diseases are often the highest, and the proportion is often several times that of other diseases. The results show that chronic diseases seriously affect the health of Chinese people, and even the hidden dangers of major injuries, which are worthy of reference by relevant government agencies