| 研究生: |
陳佑瑋 Yu-Wei Chen |
|---|---|
| 論文名稱: |
末期癌症病患的薪資所得與選擇安寧照護的關聯 |
| 指導教授: |
蔡偉德
Wei-Der Tsai |
| 口試委員: | |
| 學位類別: |
碩士 Master |
| 系所名稱: |
管理學院 - 產業經濟研究所 Graduate Institute of Industrial Economics |
| 論文出版年: | 2019 |
| 畢業學年度: | 107 |
| 語文別: | 中文 |
| 論文頁數: | 107 |
| 中文關鍵詞: | 安寧照護 、安寧選擇 、薪資所得 、醫院權屬別 |
| 相關次數: | 點閱:8 下載:0 |
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本文之研究目的為探討末期癌症病患的薪資所得與選擇安寧照護的關聯,我們以臺灣地區癌症病患為例,檢視癌末病患的薪資所得及其他需求面、供給面影響因素對於癌末病患選擇安寧照護的關聯。本研究資料來源為2000年及2005年全民健保百萬人次抽樣檔,並將癌末病患臨終前選擇安寧照護之醫療決策分為兩階段進行分析。第一階段以全體癌症病患為研究對象,我們探討癌末病患是否會選擇安寧照護,第二階段則以已經選擇安寧照護的癌末病患為研究對象,我們欲探討在癌末病患已經選擇安寧照護的情況下,會選擇何種安寧照護類型;我們也以癌末病患臨終前一段時間內安寧使用天數做為選擇安寧照護之衡量,我們則探討癌末病患安寧使用天數短期至長期的影響。此外,本研究分別使用logit迴歸模型、多元logit迴歸模型及零膨脹負二項迴歸模型做實證分析。
實證結果大多顯示高社經地位及低收入戶的癌末病患最傾向使用安寧照護,前者希望藉由使用安寧照護來改善末期的生活品質,意即高社經地位的癌末病患更重視臨終前的生活品質勝於生命的延長;後者則是因為政府及民間團體等社會救助之補貼,增加低收入戶的癌末病患使用安寧照護的財務誘因,以減輕經濟貧困家庭的財務負擔。其他需求面影響因素方面,男性、30歲以下及75歲以上的病患最不傾向使用安寧照護,臨床合併症指標分數高、罹患致死率高癌症、癌症總住院天數長及癌症總門診次數多的病患最傾向使用安寧照護。供給面影響因素方面,就診於醫學中心、宗教型醫院、就診醫院所在地區都市化程度較高的病患最傾向使用安寧照護。
The purpose of thesis is to explore the relationship between salary income and the choice of hospice care for terminal cancer patients. We take cancer patients in Taiwan as a research subject to examine the salary income and other factors of demand and supply side whether influence the termimal cancer patients to receive hospice services.The source of thesis is the 2000 and 2005 National Health Insurance Million Personnel Samples, and the choice of terminal cancer patients’s medical decision in the end-of-life is divided into two stages for analysis. The first stage is take all terminal cancer patients as research subject to examine whether patients will choose to use hospice care in the end-of-life. In the second stage, we take hospice care patients as research subject. We want to examine terminal cancer patients has chosen to use hospice care, what kind of hospice care type will be chosen. We also use the number of days of hospice care in the period before the end-of-life to examine the short-term to long-term impact of terminal cancer patients hospice care utilization. In addition, this thesis used logit regression model, multinomial logit regression model and zero-inflated negative binomial regression model for empirical analysis.
Most of the empirical results show that the cancer patients with high socioeconomic status and low-income households are most inclined to receive hospice care. The former hopes to improve the quality of end-of-life, which means that terminal cancer patients with high socioeconomic status pay more attention to the quality of end-of-life is better than the extension of life; the latter is due to subsidies from social assistance such as the government and non-governmental organization, which increases the financial incentives for cancer patients with low-income households to use hospice care to alleviate the financial burden of poor families. In terms of other demand side factors, males, patients under the age of 30 and over the age of 75 are the least inclined to use hospice care. Terminal cancer patients with high clinical comorbidity index scores, cancer with high mortality, long cancer with total inpatient days and high cancer with total outpatient service visits who is inclined to use hospice care. In terms of supply side factors, patients who are diagnosed in medical centers, religious hospitals, and those hospitals with higher degrees of urbanization where they are visiting hospitals tend to use hospice care.
一、中文部份
1. 王雲東(2005),「臺灣地區社區老人醫療服務使用率影響因素之研究-一個健康資本模型應用的初探」,社區發展季刊,110:216-230。
2. 李妙純、沈茂庭(2008),「全民健保下不同所得群體醫療利用不均因素分析」,臺灣公共衛生雜誌,27(3):223-231。
3. 朱育曾、吳肖琪(2010),「回顧與探討次級資料適用之共病測量方法」,臺灣公共衛生雜誌,29(1):8-20。
4. 何致德、林文元、林正介(2011),「安寧共同照護服務:社區推展的創新模式」,臺灣醫學,15(1):32-36。
5. 林益卿、盧建中、林盈利、徐慧娟、楊佩玉(2011),「臺日安寧療護發展之比較」,安寧療護雜誌,16(2):133-150。
6. 連賢明(2008),「如何使用健保資料進行經濟研究」,經濟論文叢刊,36(1):115-143。
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8. 陳榮基(2015),「我國安寧緩和照護之相關政策的過去發展與未來展望」,護理雜誌,62(2):13-17。
9. 陳聖雯(2015),「醫療權屬別與病患的醫療結果和醫療利用的關聯性—以乳癌病患為例」,國立中央大學產業經濟研究所碩士論文。
10. 游雅婷(2012),「專科醫師地理分布對於肝癌病患預後情況的影響」,國立中央大學產業經濟研究所碩士論文。
11. 張麗卿(2016),「病人自主權利法-善終的抉擇」,東海大學法學研究,50:1-47。
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13. 顏甄(2017),「影響癌症患者使用住院安寧療護之相關因素」,國立中山大學企業管理學系醫務管理研究所碩士論文。
二、英文部份
1. Buck, J., Webb, L., Moth, L., Morgan, L. and Barclay, S. (2018), “Persistent inequalities in Hospice at Home provision.” BMJ Supportive & Palliative Care 1:1-8.
2. Campbell, D. E, Lynn, J., Louis, T. A. and Shugarman, L. R. (2004), “Medicare program expenditures associated with hospice use.” Annals of Internal Medicine 140:269-277.
3. Chastek, B., Harley, C., Kallich, J., Newcomer, L., Paoil, C. J. and Teitelbaum, A. H. (2012), “Health care costs for patients with cancer at the end of life.” Journal of Oncology Practice 8(6):75-80.
4. Chun-Ming Chang, Chin-Chia Wu, Wen-Yao Yin, Shiun-Yang Juang, Chia-Hui Yu, Ching Chih Lee. (2014), “Low Socioeconomic Status Is Associated With More Aggressive End-of-Life Care for Working-Age Terminal Cancer Patients. ” The Oncologist 19:1241-1248.
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9. Hogan, C., Lunney, J., Gabel, J. and Lynn, J. (2001), “Medicare beneficiaries’s cost and use of care in the last year of life.” Health Affair 20:188-195.
10. Jui-Kun Ching, Yee-Hsin Kao, and Ning-Sheng Lai. (2015), “The Impact of Hospice Care on Survival and Healthcare Costs for Patients with Lung Cancer:A National Longitudinal Population-Based Study in Taiwan.” Journal of palliative medicine 19(4):380-386.
11. Lewis, J. M., Digiacomo, M., Currow, D. C., and Davidson, P. M. (2011), “Dying in the margins:understanding palliative care and socioeconomic deprivation in the developed world.” Journal of Pain and Symptom Management 42(1):105-118.
12. Lindrooth, R. C. and Weisbrod, B. A. (2007), “Do religious nonprofit and for-profit organizations respond differently to financial incentives?The hospice industry.” Journal of Health Economics 26:342-357.
13. Liu, C. N. and Yang, M. C. (2002), “National Health Insurance Expenditure for Adult Beneficiaries in Taiwan in Their Last Year of Life.” Journal of the Formosan Medical Association 101(8):552-559.
14. Markman, M. and Luce, R. (2010), “Impact of the Cost of Caancer Treatment:An Internet-Based Survey.” Journal of Oncology Practice 6(2):69-73.
15. Paul, C. L., Fradgely, E. A., Della, R. and Hannah, B. (2017), “Impact of financial costs of cancer on patients – the Australian experience.” Cancer Forum 41(2):4-9.
16. Reynolds, Tom. (2003), “Report Examines Association Between Cancer and Socioeconomic Status.” Journal of the National Cancer Institute 95(19):1431-1433.
17. Singh, G. K. and Jemal, A. (2017), “Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950-2014:Over Six Decades of Changing Patterns and Widening Inequalities.” Journal of Environmental and Public Health 138:1-19.
18. Taylor, D. H., Ostermann, J., Van Houtven, C. H., Tulsky, J. A. and Steinhauser, K. (2007), “What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?” Social Science&Medicine 65(7):1466-1478.
19. Tang, S. T., Chen, M. L., Huang, E. W., Koong, S. L., Lin G. L. and Hsiao, S. C. (2007), “Hospice utilization in Taiwan by cancer patients who died between 2000 and 2004.” Journal of Pain and Symptom Management 33:446-453.
20. Warren, J. L., Yabroff, K. R., Meekins, A., Topor, M., Lamont, E. B. and Brown, M. L. (2008), “Evaluation of Trends in the Cost of Initial Cancer Treatment.” Journal of the National Cancer Institute 100(12):888-897.
三、相關網站
1. 衛生福利部 https://www.mohw.gov.tw/mp-1.html
2. 中華民國內政部 https://www.moi.gov.tw/chi/chi_about/organization.aspx
3. 世界衛生組織https://www.who.int/en/