| 摘要: | 本研究主要是以台灣肝癌病患為研究對象，使用全民健保資料庫2000年承保抽樣歸人檔，分別從醫院及病患的角度進行探討。首先，從醫院的角度觀察醫院的醫療支出與死亡率之間的關係，並估算出生命價值，其次，從病患的角度觀察病患的醫療支出與存活天數之間的關係，並估算出病患的生命年價值。 本研究的分析方法，從醫院的角度，採用橫斷面資料以及長期追蹤資料，分別使用兩階段最小平方法、隨機效果以及固定效果進行分析；從病患的角度，則是使用存活分析中的Cox比例危險模型以及參數模型中的Log-logistic、Log-normal和Gamma三種分配的加速失敗模型進行估計，並利用估計出的邊際效果估算病患的生命年價值。 研究結果顯示，從醫院的角度，醫院病患死亡率與醫院的醫療費用呈顯著負相關，肝癌病患的生命價值約為2千5百萬到3億9千萬元；從病患的角度，個人存活天數與醫療費用呈顯著正相關，存活天數也會隨年齡的增加而減少。本研究估算從1997-2006年間，肝癌病患每年的存活收益價值為283-363萬元，餘命價值約為824-1,058萬元，而生命年價值為275-353萬元。 To estimate the value of lives by virtue of medical spending, the liver cancer patients in Taiwan were taken as subjects on this study. The data used in this paper were taken from the National Health Insurance Bureau claims data during 1996 till 2007. The analyses were performed both in hospital’s approach and the patients’ approach. First, an analysis between hospital expenses and hospital mortality was held, from which the value of life was estimated. Then, the value of a life-year was derived from another analysis between patients’ spending and patients’ survival time. In the hospital’s approach , cross section data and panel data were taken , and underwent 2SLS, random effect and fixed effect respectively for regression. In the patients’ approach, the survival analysis with Cox proportional hazard model was held, as well as 3 parametric models including log-logistic, log-normal, and Gamma distributions. From which, the marginal effect was derived and the value of a life-year estimated. As the results shown, the hospital expenses and hospital mortality are negatively related. And the value of life for the liver cancer patients ranges from 25 millions to 390 millions NTD. In the patients’ approach, patient’s spending and patient’s survival time are positively related, and the survival time decreases with age. In this study, annual value of survival gains in 1997-2006 is 2.8-3.6 millions NTD, lifetime value of survival gains is 8.2-11 millions NTD, that implied value of a life year is 2.8-3.5 millions NTD. |
