| 摘要: | 隨著文明的進步，工商業的發達，日趨嚴重的環境污染，生活環境與飲食習慣的改變，讓過敏這種文明病，在已開發和開發中國家皆呈現增加的趨勢。因國內對於異位性皮膚炎與蕁麻疹之醫療服務利用相關研究仍較缺乏，故本研究欲對我國異位性皮膚炎與蕁麻疹病患之醫療服務利用進行探討。
本研究運用全民健康保險資料庫2000至2004年之承保抽樣歸人檔第一組至第四組共二十萬人為樣本基礎，並以國際疾病診斷分類第九版臨床修正版(ICD-9-CM)出現為691.8和692.9兩者定義為異位性皮膚炎之本研究對象，及前三碼為708者定義為蕁麻疹之本研究對象。2000至2004年曾就醫治療之異位性皮膚炎病患共52,092人、蕁麻疹病患共29,778人。 研究結果發現2000至2004年異位性皮膚炎的盛行率為6%-14%、蕁麻疹的盛行率則為2%-7%，且兩病患者同樣以四歲之前為盛行率的高峰期，而盛行率最高地區為離島的澎湖縣。
2000至2004年之間，異位性皮膚炎病患的平均每人總醫療費用為2,731.98元、總藥品費970.07元。而異位性皮膚炎患者的藥品費用亦佔總醫療費用的35.5%，相較2000至2004年全國的健保藥品費佔總醫療費用比例24%-25%還高。羅吉斯迴歸分析顯示異位性皮膚炎患者在年齡、投保地區健保分局、投保金額級別，及患有合併症等相關因子與總就醫次數多寡有顯著的差異存在；總醫療費用高低則與異位性皮膚炎患者的性別、年齡、投保地區健保分局、投保金額級別、及患有合併症等相關因子有顯著的差異存在。
2000至2004年，蕁麻疹病患平均每人的總醫療費用為1,841.29元、總藥品費490.46元。但蕁麻疹患者的藥品費用僅佔總醫療費用的26.6%，並無明顯高於2000至2004年全國的健保藥品費佔總醫療費用的比例。羅吉斯迴歸分析顯示蕁麻疹患者的年齡、投保金額級別、及患有合併症等相關因子與總就醫次數多寡有顯著的差異存在。另外總醫療費用高低則與蕁麻疹患者的年齡、投保地區健保分局、投保金額級別、及患有合併症等相關因子有顯著的差異存在。
Atopic dermatitis and urticaria are two of the most common allergic skin diseases. As the progressing of civilization, the developing of business, the increasing of serious environmental pollution and the changing of life style, prevalence of atopic dermatitis and urticaria are increasing in developed and developing countries.
The purpose of this study is to explore the use of medical services for atopic dermatitis and urticaria patients. This study utilized databases of Taiwan National Health Insurance registry for beneficiaries claims to analyze allergic skin patient’s utilization of health care services from 2000 to 2004. Two codes in ICD-9-CM 691.8 and 692.9 were defined to identify atopic dermatitis patients, and the first three of the code as 708 was defined to identify urticaria patients.
The average prevalence of atopic dermatitis and urticaria were about 6%-14% and 2%-7%, respectively. The peak prevalence of both diseases was found in patients with age 0-4 from 2000 to 2004. The highest prevalence was occurred in the Penghu country.
The average of total medical fees per atopic dermatitis patient from 2000 to 2004 was NT$2,731.98 and the average of total drug fees was NT$970.07. The proportion of drug fees for the atopic dermatitis patient was 35.5% which was higher than the proportion 24%-25% of drug fees for the total of National Health Insurance (NHI).
Age, health insurance covered regional, the level of insured amount and the patient with complications were significantly related to the consultation of medical services by the logistic regression.
The total medical fees were significantly affected by gender, age, health insurance covered regional, the level of insured amount and the patient with the complications. The average of total medical fees of per urticaria patient was NT$1,841.29 and the average of total drug fees was NT$490.46 from 2000 to 2004. In the logistic regression model, the total consultation of medical services for urticaria patients were affected by age, the level of insured amount and the patient with the complications. Age, health insurance covered regional, the level of insured amount and the patient with the complications were also related to the total medical fees. |
