以高齡健保資料庫分析高齡人口醫療之需求

Abstract

古諺云：「家有一老，如有一寶」，表達社會各界對老年人的尊敬，而老年人口的比例多寡也可做為描述國家福利制度的重要指標。然而，老年人口需要較多的醫療照護等資源，臺灣人口高齡化日趨明顯也代表需要投入更多預算，加重家庭及政府的負擔。舉例來說，2016年年底臺灣65歲以上人口約13.3%，使用超過三分之一的健保資源，研究指出高齡人口在臨終前將耗費更多醫療資源(Lubitz and Prihoda 1987)；此外，醫療照護需求的比例隨年齡上升，因此照護人力及相關需求也將隨著人口老化而逐年提高。有鑑於此，本文以高齡人口的醫療及照護需求為研究目標希冀分析結果可提供政府及保險公司參考，用以制訂政策、開發保險商品改善高齡人口生活。\n本篇論文以社會保險及商業保險的角度分析高齡人口照護之需求，根據高齡健保資料庫2005年百萬老人抽樣檔（資料期間為1996年至2013年），包含承保資料檔(ID)、門診處方及治療明細檔(CD)、重大傷病證明明細檔(HV)、醫事機構基本資料檔(HOSB)以及住院醫療費用清單明細檔(DD)。研究發現全民健保確實扮演了社會保險的角色，民眾醫療支出因個體有非常大的差異（亦即不均度很高），但實施健保後的醫療支出不均度大幅下降，其中疾病（重大傷病）是造成不均度的主因，其影響程度明顯高於年齡及地區。其次，高齡人口臨終前之花費隨著死亡距離越近而越高，年紀越大之高齡人口其花費越低；高齡人口臨終前一年高人次以及高花費之疾病前者分別為本態性高血壓 、第二型糖尿病 、慢性腎衰竭、支氣管及肺惡性腫瘤及原發性肝惡性腫瘤，後者為慢性腎衰竭、敗血症、腎衰竭、惡性腫瘤以及急性呼吸衰竭。

“An elderly at home, is much alike having an invaluable treasure in hand.” is a famous Chinese saying and it represents the respect of our society to the elderly. The proportion of the elderly can also be described as an important indicator of the national welfare system. However, the elderly usually need more public resources, including medical care and thus the population aging in Taiwan indicates a heavier burden to the individuals and the public welfare. For example, the proportion of people ages 65 and over is about 13.3% but they use more than one-third of health care resources in Taiwan. Studies showed that the elderly spend more medical resources before dying (Lubitz and Prihoda 1987), and the need of medical care increases with age. In this study, we aim to explore the medical need of Taiwan’s elderly, and provide references to public policies for the government and to designing products for the insurance companies.\nWe use a database from Taiwan’s National Health Insurance, namely, the 2005 Taiwan’s Elderly Survey Database, to explore the elderly’s demand of care from the perspective of social insurance and commercial insurance. The database includes the medical records, such as ID, CD, HV, HOSB and DD. The analysis results show that NHI system did play the role of social insurance, with respect to the unevenness of individuals’ medical expenses. The disease is the main cause of unevenness, significantly higher than the factors of age and region. Secondly, the medical cost is higher as approaching the time of death. The diseases of high frequency and high cost of the elderly are essential hypertension, type II diabetes, chronic renal failure, malignant neoplasm of bronchus and lung, and so on.