Utilization of and direct expenditure for emergency medical care in Taiwan: a population-based descriptive study.
Utilization of and direct expenditure for emergency medical care in Taiwan: a population-based descriptive study.
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DOI：
10.2188/jea.je20080042
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发表时间：
2009
影响因子：
4.7
通讯作者：
Chou P
中科院分区：
文献类型：
--
作者：
Yang NP;Lee YH;Lin CH;Chung YC;Chen WJ;Chou P
本研究以台湾急诊医疗系统（EMS）为研究对象，旨在为国家医疗资源再分配决策提供参考。本研究采用系统抽样的方法，从2000年至2004年的全民健保数据库中，随机抽取具有代表性的数据库。我们分别在2000年、2001年、2002年、2003年和2004年确定了10,124、10,408、11,209、10,686和11,914次急诊室就诊。男性多于女性，大多数成年人年龄在50岁以下。损伤/中毒诊断是台湾急诊科最常见的诊断类别。合并2例和3例患者分别为13196例（24.3%）和2952例（5.4%）。高龄与多重诊断存在显著相关性（P < 0.001）。除了不明确的症状/体征/状况外，65岁或以上患者最常见的两种诊断是循环系统疾病和呼吸系统疾病。台湾急诊科的治疗相关费用和药物相关费用平均分别为新台币1,155元（35.0美元）和新台币190元（5.8美元），分别占急诊科相关费用总额的64.5%和10.6%。普通急诊科医疗费用随患者年龄增加而增加；年龄增加的费用比率估计为每年8% （P < 0.001）。在急诊科就诊时诊断出重大健康问题的频率因年龄而异：更复杂的抱怨和多重诊断在老年患者中更常见。在台湾，急诊科系统仍然超负荷，可能是因为急诊科的费用很低。
We surveyed the emergency medical system (EMS) in Taiwan to provide information to policymakers responsible for decisions regarding the redistribution of national medical resources. A systematic sampling method was used to randomly sample a representative database from the National Health Insurance (NHI) database in Taiwan, during the period from 2000 to 2004. We identified 10,124, 10,408, 11,209, 10,686, and 11,914 emergency room visits in 2000, 2001, 2002, 2003, and 2004, respectively. There were more males than females, and the majority of adults were younger than 50 years. Diagnose of injury/poisoning was the most frequently noted diagnostic category in emergency departments (EDs) in Taiwan. There were 13,196 (24.3%) and 2,952 (5.4%) patients with 2 and 3 concomitant diagnoses, respectively. There was a significant association between advanced age and the existence of multiple diagnoses (P < 0.001). With the exception of the ill-defined symptoms/signs/conditions, the two most frequent diagnoses were diseases of the circulatory system and diseases of the respiratory system in patients aged 65 years or older. On average, treatment-associated expenditure and drug-associated expenditure in Taiwan EDs averaged NT$1,155 ($35.0) and NT$190 ($5.8), respectively, which was equal to 64.5% and 10.6% of the total ED-associated cost. General ED medical expenditure increased with patient age; the increased cost ratio due to age was estimated at 8% per year (P < 0.001). The frequency of major health problems diagnosed at ED visits varied by age: more complicated complaints and multiple diagnoses were more frequent in older patients. In Taiwan, the ED system remains overloaded, possibly because of the low cost of an ED visit.