末期癌症病患的薪資所得與選擇安寧照護的關聯

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Title:	末期癌症病患的薪資所得與選擇安寧照護的關聯
Authors:	陳佑瑋;Chen, Yu-Wei
Contributors:	產業經濟研究所
Keywords:	安寧照護;安寧選擇;薪資所得;醫院權屬別
Date:	2019-07-24
Issue Date:	2019-09-03 15:14:15 (UTC+8)
Publisher:	國立中央大學
Abstract:	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.
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