| Summary: | 碩士 === 慈濟大學 === 公共衛生學系碩士班 === 106 === Background and purpose：The incidence and mortality of cancer increased gradually year by year in Taiwan. Treatment of cancer patients led to the high medical expenditure, named as “the high cost of dying”. It indicated that patients consumed lots of medical resources and costs at end of life. Cancer was the catastrophic illness and needed complete medical resources for treatment. It was worth to discuss medical utilization, expenditure and patient flow among cancer patients in remote areas where there was less of medical resources.
Methods：The data of this study was from the National Cohort of 2-million Dataset 2005 obtained from The Center for Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan. This study was conducted using the “Cause Of Death Data” and “ National Health Insurance research database.” The participants in this study included patients who died of cancer and lived in remote areas among 48 villages and towns. Control group who was lived in non-remote areas determined by 1:1 matching. This study would show the difference in medical utilization, expenditure and patient flow at last year of life among cancer patients between the different areas.
Results：Medical utilizations for remote cancer patients at last year of life were higher for outpatient visits (38.97 vs 34.84) and shorter for length of stays (11.97 vs 13.42). Medical expenditure for remote cancer patients was lower on outpatient expenses (98,295 vs 121,805), and cross-region utilization for remote cancer patients was higher (36.89% vs 28.16%). Differences of medical utilization, expenditure and patient flow for cancer patients who need active treatment and hospice care were influenced by geographic variation.
Conclusions：Health care access for remote people was increasing after IDS implementation. But there’s difference of medical utilization, expenditure and patient flow for patients with catastrophic illnesses between urban and remote area at end of life. The results of this study could be used as a reference for future research and policy development.
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