Senior People’s Medical Record Characteristics and Related Factors of Healthcare Insurance Payment

[[abstract]]台灣已逐步進入高齡化社會，健康照護和醫療保險成為許多人關注的議題。在全世界資訊系統愈來愈發達的情形下，醫療大數據已經重新定義了醫療保健的提供模式。相較大數據在其他行業的運用朝向「客製化」和「精準化」的發展，在未來大數據的浪潮下，醫療大數據的進一步發展就必須建立在資料庫連結的一個前提。醫療行政是政府、醫院、醫師、藥物、患者和醫療保險（花費）六大因素的配置，本研究透過彙集因醫療行業運轉所產生的資料進行連結所產生之數據進行分析，達到資源最佳配置與多贏的局面，降低醫療工作人員的負擔，使其可以更容易做出精準的醫療判斷，為本研究之動機。台灣在1995年實施全民健康保險，讓國人在醫療品質上有安全保障，同時也累積龐大的健保資料庫，於2000年開放產官學界於非商業性質研究，提供醫療用藥安全、醫療健康科技、健保醫療經濟及財務學的研究與政策制定的參考與依據。本研究的範圍為2001年至2013年，依十大死因衍生出十大疾病，分析銀髮族罹患此十大疾病在門診和住院的逐年概況與花費，並進一步調查十大疾病之間的交互作用（共病現象）以及闡述各種趨勢的可能原因。未來影響台灣經濟面向的人口議題，亦是人口年齡的結構變化，而非人口數量的變化，人口老化將導致健康照護、社會保險和福利支出的增加，造成國家整體財政負擔加重，進而使得年輕世代勞動者負擔變大。因此，人口老化帶來國家社會面臨更多挑戰，既然人口老化帶來衝擊無法避免，如何透過政策來提高老人人口的社會價值，為本研究報告探討範圍，提出成果及貢獻。[[abstract]]Taiwan has gradually evolved into an aging society. Healthcare and medical insurance have become concerned issues for many people. Against the backdrop of increasingly developed information system across the world, medical big data has already re-defined healthcare supply pattern.Compared with “customization” and “precision” developments for big data’s utilization in other industries, healthcare big data’s further development under the wave of future big data must be established based on the premise of database linkage. Healthcare administration is the allocation of six major factors of government, hospital, doctor, medicine and patient’s healthcare insurance (expense). This research collected data generated from linkage of materials incurred from healthcare industry’s operation, and conducted analysis accordingly for the purposes of reaching optimal resource allocation and win-win situation, and lowering healthcare workers’ burden to ensure that they are able to make precision healthcare judgement easily. This is the motive for the research hereto. Taiwan implemented National Health Insurance in 1995. This ensures healthcare safety protection for fellow countrymen. Meanwhile an enormous health insurance database was established accordingly. In the year of 2000, it was opened to industry, public and academic sectors for non-commercial research. This provides research on healthcare drug safety, healthcare technology, health insurance economics and science of finance as well as references and basis for policy establishment. Scope of this research spans from 2001 to 2013. Ten major diseases were derived from ten major causes of death. This is utilized to analyze yearly overview and costs incurred from outpatient and inpatient for senior people having these ten major diseases. Meanwhile, a further investigation of interactions (comorbidity) among these ten major diseases is conducted to for the purpose of explaining possible causes for various trends. Going forward, population issue affecting Taiwan’s economy will be structural changes in population age instead of changes in population quantity. Aging population will lead to increases of expenditure in healthcare, social insurance and welfare as well as aggravation on the nation’s overall financial burden. Consequently, aging population brings even more challenges to the nation and the society. Given the fact that aging population is inevitable, exploration scope of this research report aims at presenting future expected achievements and contributions by enhancing senior population’s social values through policies