台灣地區五大盛行癌症(肺癌,肝癌,大腸直腸癌,乳癌(針對女性)及胃癌)之醫療資源使用: 2001~2003

[[abstract]]背景：自1995 年台灣實施全民健保後，截至目前為止，國內關於癌症治療所使用之 全民健保給付之研究，仍然相當缺乏。目前國內相關研究多使用健保資料庫之費用科 目進行分析，然而，如此分析無法有效呈現癌症治療成本之特性，有必要進行更深入 之分析。本研究主要之研究目的為針對台灣五大盛行癌症（肺癌、肝癌、大腸直腸癌、 胃癌、女性乳癌），分析其2001 年至2003 年之：(1)罹患人數及其趨勢，(2)接受化學 治療人數及其趨勢，(3)所申報之健保給付及其趨勢，(4)全民健保癌症治療用藥給付 結構(分成化學治療、賀爾蒙治療以及支持性療法)及其趨勢。 資料與方法：本研究採回溯式觀察性研究設計(retrospective observational study design)， 研究對象為「全民健康保險研究資料庫」(National Health Insurance Research Database, NHIRD)中之「癌症特定主題專檔」裡2001 至2003 年度「門診處方及治療 明細檔」(簡稱CD 檔)中所載主診斷代碼(ICD-9-CM code)為肺癌,肝癌,大腸直腸癌,胃 癌,女性乳癌之所有病患，同時透過特殊需求申請，將其他三大承保資料檔一併申請： 「門診處方醫令明細檔」(簡稱OO 檔)、「住院醫療費用清單明細檔」(簡稱DD 檔)以 及「住院醫療費用醫令清單明細檔」(簡稱DO 檔)，並進行串檔分析。統計方法主要 使用敘述性統計為主，同時計算其三年內之年增率。此外，本研究使用無母數迴歸 (nonparametric regression method)探討歷年接受化療的人數與癌症治療給付之關聯性。 結果：三個年度五大盛行癌症共計約508,981 筆(人次)之資料，納入本研究之分析。 五大盛行癌症於2001 至2003 年間，罹患肺癌、肝癌以及胃癌的人數，大致維持一定。 然而，大腸直腸癌及乳癌之罹患人數，皆呈現上升的趨勢。其中，尤以女性乳癌罹患 人數增加幅度最大，其次為大腸直腸癌。再者，五大盛行癌症接受化學治療之人數， 亦大致呈現上升之趨勢，尤以女性乳癌接受化學治療之人數增加幅度最大，其次為大 196 C. Y. Liu et al./JCOS 25(2009) 195-205 腸直腸癌。在所申報之健保給付(門診與住院)部分，五大盛行癌症皆呈現上升的趨勢， 尤以女性乳癌所申報之健保給付增加幅度最大，其次為大腸直腸癌。另外，在女性乳 癌的治療上，支持性療法所佔的比率最高(約17%)，其次為肝癌(約3%)。五大盛行癌 症在總用藥健保支出上皆呈現上升之趨勢，尤其以女性乳癌之用藥健保給付增加幅度 較大，其次為大腸直腸癌。最後，在門診與住院成本部分，以平均一位病人一年健保 給付來計算，門診健保給付以肺癌與乳癌最高(年平均超過新台幣35,000 元以上)；而 住院健保給付方面，亦以平均一位病人一年所需健保給付來計算，以肺癌、大腸直腸 癌及胃癌的住院健保給付最高(年平均約新台幣150,000 元以上)。此外，在歷年接受 化療的人數是否與每年癌症治療給付的關連性研究部分，每增加一位接受化療之肺癌 病患，健保給付約增加新台幣14 萬元，大腸直腸癌約為11 萬元，乳癌病人約為10 萬元。 結論：本研究對於台灣近年來盛行癌症之接受化學治療人數與健保給付之關係、有無 接受化學治療人數之歷年趨勢與年增率、以及接受化學治療與支持療法人數之歷年趨 勢與年增率提出一個具台灣人口代表性實證研究。研究結果顯示，癌症病患接受化學 治療的人數以及所耗用的全民健保成本接逐年增加。面對此一增加的趨勢，不僅對癌 症病患及其家屬造成不輕的經濟負擔，也同時會影響全民健康保險資源之配置。[[abstract]]Background: Since the inception of the National Health Insurance (NHI) in 1995, studies on NHI reimbursement for cancer treatment have been lacking. Published studies used the cost items from the Bureau of National Health Insurance (BNHI) database, however such cost items do not clearly reflect the real cost structure of cancer treatment, and therefore, further studies are needed. This study was aimed at studying: (1) the incidence trend of prevalent cancers in Taiwan; (2) the trend of cancer patients receiving chemotherapy; (3) the trend of BNHI claimed medical costs of prevalent cancers; (4) the trend and the cost structure of cancer treatments (divided into chemotherapy, hormone therapy and supportive treatment). Methods: This study adopted a retrospective observational design and the data were retrieved from the National Health Insurance Research Database (NHIRD), which is managed by the National Health Research Institutes (NHRI). This study linked the four main databases of NHIRD: CD, DD, OO and OD, to form a complete cancer research database. This study mainly adopted descriptive statistical methods to display data and time trend. In addition, this study used nonparametric regression to investigate the relationship between annual patient number and NHI reimbursement. Results: A total of 508,891 records (five prevalent cancers in three years) were eligible. The number of patients with lung cancer, liver cancer and gastric cancer showed remained stable in these three years, however, the number of patients with colorectal cancer and women’s breast cancer showed an increasing trend in these three years. Women’s breast cancer had the highest annual increase, followed by colorectal cancer. The number of cancer patients receiving chemotherapy also showed an increasing trend for the five cancers. The highest annual increase rate was seen for women’s breast cancer, followed by colorectal cancer. The total amount of NHI reimbursement for these five cancers also showed an increasing trend, especially for women’s breast cancer, which had the highest annual rate increase. The highest percentage of hormone therapy was for women’s breast cancer (17%). The total amount of drug cost also showed an increasing trend for these five cancers, led by women’s breast cancer. Lung cancer and breast cancer had the highest average outpatient cost for each patient per year (over NTD$35,000), while lung cancer, colon cancer and gastric cancer had the highest average inpatient cost for each patient per year (over NTD$150,000). Overall, the total outpatient and inpatient costs showed an increasing trend in recent years. Finally, the NHI reimbursement increased to NTD$140,000 for each lung cancer patient, NTD$110,000 for each colon cancer patient and NTD$100,000 for each women’s breast cancer patient. journal homepage:www.cos.org.tw/web/index.asp 中華癌醫會誌 (J. Chinese Oncol. Soc.) 25(3), 195-205, 2009 Conclusions: This study of the incidence trend and the cost structure of cancer treatment was highly representative of the Taiwanese population, and it showed a positive correlation between annual cancer patient number and NHI reimbursement and an increasing trend for chemotherapy, hormone therapy and supportive treatment. The results also showed that the number of cancer patients receiving chemotherapy, the total amount of NHI reimbursement and the drug costs had increasing trends in recent years. This increased the financial burden of cancer patients and may alter the allocation of NHI resources

一個發生財務危機企業其資金缺口「混沌現象」之模擬

[[abstract]]本研究之目的係藉由觀察企業經營過程所產生資金缺口是否出現混沌現象，來探討預防企業發生財務危機。並且討論﹕對於不同時期，不同的短期負債威脅及不同的銷售量變化影響下，對於資金缺口變化傾向之影響，以及求出資金缺口變化傾向發生混沌現象之臨界時間尺度(Critical Time Scale)，藉以探討企業主所應採用之時間尺度(Time Scale)為何。模擬結果顯示，藉由觀察企業經營過程所產生資金缺口變化傾向是否出現混沌現象來預測企業財務危機之發生是一個可行的途徑，並且收集行政院金融監督管理委員會證期局所公佈之重大事件，編撰成企業事件編年表(Events Synchronism)作為模擬結果的對照，得到實際的印證

一個發生財務危機企業其資金缺口「混沌現象」之模擬

[[abstract]]本研究之目的係藉由觀察企業經營過程所產生資金缺口是否出現混沌現象，來探討預防企業發生財務危機。並且討論﹕對於不同時期，不同的短期負債威脅及不同的銷售量變化影響下，對於資金缺口變化傾向之影響，以及求出資金缺口變化傾向發生混沌現象之臨界時間尺度(Critical Time Scale)，藉以探討企業主所應採用之時間尺度(Time Scale)為何。模擬結果顯示，藉由觀察企業經營過程所產生資金缺口變化傾向是否出現混沌現象來預測企業財務危機之發生是一個可行的途徑，並且收集行政院金融監督管理委員會證期局所公佈之重大事件，編撰成企業事件編年表(Events Synchronism)作為模擬結果的對照，得到實際的印證

台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究

[[abstract]]自從羅啟宏(1992)提出「台灣省鄉鎮發展類型之研究」一文後，利用普查資料或是其他輔助資料進行台灣地區鄉鎮市區都市化發展型態之研究，逐漸受到國內各類大型調查在進行分層抽樣設計的重視與應用。為了使2005年「國民健康訪問調查」其樣本更具鄉鎮市區發展類型之代表性，本文使用台灣最近一次之「戶口普查資料檔」（2000年）與同時期之「台灣各縣市統計要覽」以及「衛生署醫療機構現況及醫療服務統計量」資料庫來進行台灣地區鄉鎮市區都市化程度分層之研究。研究變數包括人口密度（人／平方公里）、專科以上教育程度人口比率、65歲以上人口比率、農業人口比率與每10萬人西醫人數，並使用集群分析進行研究。結果將台灣地區359個鄉鎮市區分成七個都市化程度之集群：「高度都市化市鎮」、「中度都市化市鎮」、「新興市鎮」、「一般鄉鎮市區」、「高齡化市鎮」、「農業市鎮」與「偏遠鄉鎮」。本論文結果亦已被2005年「國民健康訪問調查」所採用，做為進行分層多階段、抽取率與單位大小成比例之等機率抽樣設計之參考

Factors associated with subsequent eye care for children in Taiwan: a population-based historical cohort study.

[[abstract]]PURPOSE: To investigate patterns and factors associated with subsequent eye care for Taiwan's children. METHODS: We conducted a population-based historical cohort study of 2464 children aged between 3 and 12 years old from the 2005 National Health Interview Survey (NHIS). Participants' ocular conditions were identified based on 2005 NHIS questionnaire answers given by caregivers. Subsequent eye care data was obtained from 2006 and 2007 National Health Insurance claim data. Eye care related to these children's ocular conditions was defined by physician's diagnosis using the International Classification of Diseases version 9 clinical modification codes. Poisson regression with robust variance estimation was used to determine factors associated with eye care use. RESULTS: Of the 2464 children, 712 (28.9%) had ocular conditions in 2005, and 56.5% and 44.7% of them didn't receive eye care during the subsequent 1- and 2-year periods, respectively. Among those with ocular conditions, the 3-4-year-olds were least likely to receive eye care in the subsequent 1 and 2 years. Children with highly educated fathers were more likely to receive eye care in the subsequent 1-year period. Sex, family income, level of mother's education, residential area and eye care resources were not significant factors for children with ocular conditions receiving subsequent eye care within either 1 or 2 years. CONCLUSIONS: Despite the fact that Taiwan has a National Health Insurance Program, lack of subsequent eye care remains high, even when a child's ocular condition is known by the caregiver. Determinants associated with follow-up eye care must be considered when designing eye care enhancing programs for children

Increased risks of congenital, neurological and endocrine disorders associated with autism in preschool children: cognitive ability differences

[[abstract]]OBJECTIVE: To investigate the increased risk of congenital, neurologic, and endocrine disorders in autistic preschool children and to probe possible cognitive impairment-associated variation in such risks. STUDY DESIGN: Using a population-based longitudinal study, a total of 3440 autistic children born in 1997-1999 and 33,391 age- and residential urbanicity-matched control subjects were identified from the National Health Insurance Research Database in Taiwan. Conditional logistic analyses were performed to estimate the strength of association stratified by the presence of cognitive impairment. RESULTS: Autistic children were found to have greatly elevated risks of congenital anomalies (eg, tuberous sclerosis: adjusted odds ratio [aOR] = 34 approximately 61) and neurologic disorders (eg, epilepsy: aOR = 5 approximately 13) compared with their matched nonautistic peers. The increased risk of medical diseases for mentally retarded autism were approximately 1.6 to 9 times greater than those for isolated autism. CONCLUSIONS: The observed cognitive impairment-related variation in the increased risk of congenital, neurological, and endocrine disorders with autism may provide some clinical and etiologic implications that warrant investigation in the future