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題 名 | 臺灣省推行糖尿病、高血壓社區篩檢工作之成本分析=Cost Analysis of Diabetes and Hypertension Mass Screening in Taiwan Province |
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作 者 | 楊瓊珠; 鄧玉貴; 邱美汝; 林綽娟; | 書刊名 | 中國醫藥學院雜誌 |
卷 期 | 7:4 1998.12[民87.12] |
頁 次 | 頁153-162 |
分類號 | 412.775 |
關鍵詞 | 中老年疾病防治; 社區高血壓篩檢; 社區糖尿病篩檢; 成本分析; Adult disease control program; Community diabetes screening; Community hypertesion screening; Cost of mass screening; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究係調查臺灣省政府衛生處自民國 79 年到民國 80 年間執行全省 21 縣市 社區糖尿病及高血壓篩檢工作所支出之成本;篩檢工作之單次成本;及發現一個慢性病患者 的單次成本,以評估本次篩檢工作之成本效益而為我國日後推展中老年病防治計劃之參考。 本研究係對全省 21 縣市 335 個衛生所之基層工作人員 2667 位進行調查,回收 2556 份,其回收率為 95.8%,調查表為研究者經參考國內外文獻自擬之。並由各縣市衛生局中老 年病防治工作負責人員協助收集資料。調查表收回後經整理、統計、分析,獲致下列結果: 臺灣省執行高血壓、糖尿病社區篩檢工作之篩檢單次成本約為 236 元, 發現一個高血 壓患者之成本約需 1475 元,發現一個糖尿病患者之成本約為 5900 元。篩檢成本中以人事 費佔最高,以初次篩檢而言,人事費佔成本的 78%,其它的設備費、材料費等僅佔 23%,如 此龐大的人事費,實是推行衛生政策須考慮之重點。 本研究顯示臺灣省推行中老年病防治工作,其花費於執行篩檢技術的時間,平均每例為 十四分鐘,約佔篩檢總時間 19%,而其花費於準備、交通,登記報表等時間,雖非每案逐一 作業, 但經合算約佔六十三分鐘( 81% ),足見基層工作人員投入大量工時於中老年病防 治計畫,而其中絕大部分為間接工作所需時間。 依據以上結論本研究提出四項建議: (一)臺灣省推行中老年病防治計畫之成本過高,其成本效益有待商榷。其於本省公共衛生 政策上,所扮演的優先順序,亦需重新檢討。 (二)臺灣省推行中老年病防治計畫之成本之中,人事費所佔比例偏高,故中老年病防治計 畫之工作方式,需重新考慮。 (三)由於衛生處所辦理之學童尿液篩檢,係委託法人機構辦理代檢,而篩檢之費用為每案 34 元,但自行辦法社區高血壓或糖尿病篩檢之費用,卻需每案 236 元,相距甚大,不合經 濟效益。故政府於推行此類計畫時,宜考慮委由民間機構辦理。 (四)建議由衛生所發給中老年人每人一張健康管理卡,每人每年可篩檢血壓、尿糖、血糖 各一次;各醫療機構、如診所、醫院均可接受中老年人執卡篩檢;衛生機構給付執行篩檢之 醫療機構該項費用,並檢出有病者進行追蹤輔導。 |
英文摘要 | The purpose of this study is to evaluate the proportion of running cost of the scheme "Community screening program for diabetes and hypertension in Taiwan Province" which was promulgated since 1990. The running cost for single manipulation of screening procedure; the running cost for picking up single case of sickness is also investigated. A questionnaire for this purpose was handed to all 2667 public health workers who were participated in this scheme in 335 health stations of 21 cities and counties in Taiwan Province. The recovery rate of the questionnaire is 95.8%. Verification of returned questionnaires was conducted by the test of validity and reliability and through sending troops of investigations to visit the randomized selected health stations and to interviewing health workers of this concern. No significant result was proved between two different procedures. This study shows that the running cost for single manipulation of screening procedure is estimated to be N.T.$236. The cost of discovering one case of diabetes and hypertension is N.T.$5,900 and 1,475 respectively. Analysis on the parameter of expenditure involved shows that 78% of the total screening expenditure is personnel related expense yet, remaining 23% contains all other costs viz. material, equipment, fuel, etc. The time consumption by the screening process per se is 14 minutes for every manipulation yet, for screening related paper work, preparation, transportation, persuasion, etc. consumes additional 63 minutes to complete a case. This study suggested that. 1. The scheme "Community screening program for diabetes and hypertension in Taiwan Province" is necessarily be reconsidered for its continuation because of the expensiveness and inefficiency. 2. The scheme is necessarily be revised in the containment of its personnel related expenses, inefficient bureaucracy, and/or redesigning proper strategy. 3. To render the scheme to non-governmental organization is much more cost-beneficial. Since disease prevention and health promotion are more important issues of a governmental scheme. 4. A strategy of administering "Adult health registration" system might provide better solution to the scheme. All target population who are eligible for periodic medical checkups, including this scheme if necessary, are registered and served by assigned clinics on fee-for-service basis. It is concluded that the present scheme of "Community screening program for diabetes and hypertension in Taiwan Province" is an expensive and inefficient public health program. To render the program for private organization is strongly suggested. |
本系統中英文摘要資訊取自各篇刊載內容。