2001年至2003年台灣五大盛行癌症（肺癌，肝癌，大腸直腸癌，胃癌，女性乳癌）全民健保給付之探究

Abstract

Background: Since the inception of the National Health Insurance (NHI) in 1995, studies on NHI reimbursement for cancer treatment have been lacking. Published studies used the cost items from the Bureau of National Health Insurance (BNHI) database, however such cost items do not clearly reflect the real cost structure of cancer treatment, and therefore, further studies are needed. This study was aimed at studying: (1) the incidence trend of prevalent cancers in Taiwan; (2) the trend of cancer patients receiving chemotherapy; (3) the trend of BNHI claimed medical costs of prevalent cancers; (4) the trend and the cost structure of cancer treatments (divided into chemotherapy, hormone therapy and supportive treatment). Methods: This study adopted a retrospective observational design and the data were retrieved from the National Health Insurance Research Database (NHIRD), which is managed by the National Health Research Institutes (NHRI). This study linked the four main databases of NHIRD: CD, DD, OO and OD, to form a complete cancer research database. This study mainly adopted descriptive statistical methods to display data and time trend. In addition, this study used nonparametric regression to investigate the relationship between annual patient number and NHI reimbursement. Results: A total of 508,891 records (five prevalent cancers in three years) were eligible. The number of patients with lung cancer, liver cancer and gastric cancer showed remained stable in these three years, however, the number of patients with colorectal cancer and women's breast cancer showed an increasing trend in these three years. Women's breast cancer had the highest annual increase, followed by colorectal cancer. The number of cancer patients receiving chemotherapy also showed an increasing trend for the five cancers. The highest annual increase rate was seen for women's breast cancer, followed by colorectal cancer. The total amount of NHI reimbursement for these five cancers also showed an increasing trend, especially for women's breast cancer, which had the highest annual rate increase. The highest percentage of hormone therapy was for women's breast cancer (17%). The total amount of drug cost also showed an increasing trend for these five cancers, led by women's breast cancer. Lung cancer and breast cancer had the highest average outpatient cost for each patient per year (over NTD$35,000), while lung cancer, colon cancer and gastric cancer had the highest average inpatient cost for each patient per year (over NTD$150,000). Overall, the total outpatient and inpatient costs showed an increasing trend in recent years. Finally, the NHI reimbursement increased to NTD$140,000 for each lung cancer patient, NTD$110,000 for each colon cancer patient and NTD$100,000 for each women's breast cancer patient. Conclusions: This study of the incidence trend and the cost structure of cancer treatment was highly representative of the Taiwanese population, and it showed a positive correlation between annual cancer patient number and NHI reimbursement and an increasing trend for chemotherapy, hormone therapy and supportive treatment. The results also showed that the number of cancer patients receiving chemotherapy, the total amount of NHI reimbursement and the drug costs had increasing trends in recent years. This increased the financial burden of cancer patients and may alter the allocation of NHI resources.