The Impact of Breast Cancer Case Management on Quality of Life and Survival among Private Health Insurance Enrollees

Autor: Shu-Fang Lee, 李淑芳
Rok vydání: 2012
Druh dokumentu: 學位論文 ; thesis
Popis: 100
Breast cancer is the most prevalent cancer in women worldwide. Along with the advance in medical technology, healthcare quality improves. However, being restrained by the financial factor of National Health Insurance (NHI) increases financial risk, which leads to rising out-of-pocket expenses. The application of health management in health or medical insurance industry mainly reduces the risk of suffering from the disease and reimbursement. Many literatures had explored the effectiveness of case management. For the insurance industry, effectively reducing medical expenses and increasing revenue is a win-win situation. This study is to explore the total medical expenses of people with breast cancer and the effectiveness of implementing case management on the commercial insurance. The result can be the reference of future company planning on case management and encourage more companies to invest more resources into the health researches. Besides, this study is to truly reflect the cost of treating breast cancer and to provide the healthcare policy scholars a reference to develop the ultimate health welfare policies and the resource allocation of NHI for breast cancer patients. The database of commercial insurance company claim data is used and the subjects are the insured breast cancer patients with medical or cancer insurance. Among them, the ones participated the case management service of insurance company are assigned as the experimental group and those who did not are the control group. We explore the trend of first-year treatment expenses of the insured breast cancer patients and the difference in satisfaction of life quality and survival rate between the two groups. The results are followed: First, the first-year breast cancer treatment expenses accounts for the highest proportion of NHI payment in each year and slows down in the following years. NHI pays for 40% percent of the total medical expenses and 60% are paid out-of-pocket. The average expenses of the first-year breast cancer treatment is 323,463 and out-of-pocket is 191,557. The total medical expenses after suffering from the disease are half of the annual income, which states that the coverage of NHI is obviously short of the need. The out-of-pocket expenses on the ward and drugs take up 80% and 70% of the total medical expenditure respectively. Second, multivariate analysis and propensity score are adopted to adjust for sample selection bias. The mortality rate of the experimental group is 0.21 to 0.27 lower of the control group and the survival rate of the experimental group is higher than the control. Third, before the adjustment, the experiment group is mostly higher in life quality than the control group. After adjusting some variables, including group, age, period, education and hospital and applying Propensity Score to minimize selection bias, the experimental group is significantly better than the control group in “future prognosis” and “symptoms of arms”(such as swelling, painful and stretch difficulty). In this study, the gap of breast cancer medical expenses generated by the social insurance emphasizes the importance of the commercial insurance to patients. The efficiency from case management is crucial not only in survival rate and life quality satisfaction, but also in promoting the image of health industry and raising the reliability and trust of the insured for the insurance company or purchasing more policies and referring the potential client list. We expect this study would stimulate more commercial insurance companies to invest resources into case management in order to reach a win-win-win situation among the society, the industry and the insured breast cancer patients. Keywords: breast cancer, case management, survival rate, life quality satisfaction
Databáze: Networked Digital Library of Theses & Dissertations
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