23卷5期

• Link 公衛論壇 Public Health Forum
• 談社經因素在流行病學研究之角色談社經因素在流行病學研究之角色
• 林宜平、呂宗學
  Yi-Ping Lin, Tsung-Hsuen Lu
• 無
  none
• 無
  none
• 335 - 337
• 10.6288/TJPH2004-23-05-01

• Link 綜論 Review Article
• 疾病費用統計分類群組架構相關問題探討兼介紹疾病分類軟體Problems Related to Disease Classification Grouping Schemes in the Cost-Of-Illness Tabulation and Introduction of Clinical Classification Software
• 張鴻仁、任一安、周穎政、呂宗學
  Hong-Jen Chang, Ian Jen, Yiing-Jenq Chou, Tsung-Hsueh Lu
• 疾病費用 ； 疾病分類 ； 診斷 ； 申報資料 ； 健康服務研究
  cost of illness ; classification of disease ; diagnosis ; claims data ; health service research
• 疾病費用統計是健康服務研究與行政管理決策經常使用的訊息。為了疾病別費用統計製表，我們有必要將上萬個國際疾病分類四位碼與五位碼合併為有限數目的群組，才可能進行有意義的討論與分析。本文的目的有三：首先想回顧過去疾病費用比較研究常用哪些疾病分類群組架構？傳統疾病分類群組架構有哪些優缺點？本文最後再針對目前最新的疾病分類群組架構做更詳細的介紹，並檢討台灣使用此分類架構之可行性。以「章別」作為群組架構的缺失為：（1）分類群組名稱太籠統且不特定；（2）不同群組所包括的分類項數目差異太大；（3）同一章內疾病異質性還是很大。以「基本表」作為群組架構的缺失為：（1）其他殘餘分類項疾病數目太多；（2）無法克服跨章分類的限制。為解決上述缺失，美國醫療照護研究品質局提出「臨床分類軟體」，可以將分散不同章節相同病因的診斷合併，有效減少症狀、徵候及診斷欠明分類項及其他殘餘分類項的數目，因此可以提供較特定有用之訊息提供排序比較。不過，使用此改良分類群組架構時，還是要小心健保申報資料疾病診斷準確度與多重診斷費用歸類的問題。
  Cost-of-illness tabulations are commonly used information in health service researches and administration decision-making. In order to tabulate the disease-specific cost of an illness, a scheme of grouping disease categories is needed in order to cluster related 4-digit or 5-digit categories into a meaningful and manageable number for the purposes of analysis and discussion. The aim of this study was to discuss the problems of currently used grouping scheme and to find out the modified grouping schemes that intended to resolve these problems. The problems in using the ‘chapter’ as a grouping schemes include: (1) the titles of the groups are too general and non-specific; (2) the number of categories within each group varies greatly; (3) diseases classified within the same ICD chapter are too heterogeneous. The problems in using the ‘basic’ tabulation list’ as a grouping scheme include: (1) categories and number of disease in other residual groups are too large, and (2) diseases with similar etiology are scattered into different bodily organ system chapters. The Clinical Classification Software (CCS) grouping scheme was developed by the Agency for Healthcare Research and Quality (AHRQ) to solve the above problems. The CCS could efficiently reduce the number of ‘other...’ residual groups and of Chapter XVI ‘signs, symptoms, and ill-defined conditions’ and generally provides more specific information. Nevertheless, we should not overlook the problems of accuracy of diagnosis and multiple diagnoses in claims data.
• 338 - 354
• 10.6288/TJPH2004-23-05-02

• Link 原著 Original Article
• 利用變異數組成模式對數量性狀基因座的貝氏統計推論Bayesian Inference of Gnetic Vriance of QTL Via Variance Component Model
• 吳淑惠、蕭朱杏
  Shu-Hui Wu, Chuhsing Kate Hsiao
• 貝氏統計推論；主效基因；數量性狀；變異數組成模式；Gibbs抽樣方法
  Bayesian ; major gene ; quantitative trait ; variance component model ; Gibbs sampling
• 目標：利用貝氏的點估計值來提供一個估計主效基因的變異數的更簡便方法；一旦估計值可被確定，所利用之標識基因可被判斷是否與主效基因有連鎖，再進一步作基因定位分析。方法：將數量性狀的變異數分成主效基因的變異、主效基因以外的其他遺傳變異和環境的變異等三個成份來討論，再利用貝氏方法及最大概似法對三個變異數成份作估計以進行統計推論。事後樣本的取得會利用Gibbs抽樣方法以及Markov chain Monte Carlo法。結果：以核心家庭有兩位子女的情況作模擬，經由結果顯示，對於主效基因的變異數估計，貝氏方法確實比最大概似估計法較穩定且精確。結論：相較於最大概似法，貝氏分析確實提供了精確的估計方法，而且本文利用WinBUGS1.3的程式可以獲得事後機率的樣本，可利用這些事後樣本做進一步的包含機率意義的統計推論，這是傳統統計方法所無法達到的目標。若是推廣到較複雜的遺傳模式，如主效基因不只有一個，或者改變事前分配，則此遺傳模式也可以很容易地被改寫，再利用現有統計軟體計算出結果，作為未來進一步定位之用。
  Objectives: To estimate more efficiently the variance of the major gene via Bayesian method. Methods: The variance component model is considered for the quantitative trait. The model comprises a polymorphic single major gene, polygene, and a random environmental effect. Two different approaches, maximum likelihood and Bayesian estimate, are compared in terms of the estimation of the three variance parameters of interest. The inference of the posterior distribution and posterior samples of the parameters, particularly the additive variance of the single major gene, are made via Markov chain Monte Carlo method using WinBUGS1.3. Results: Simulations are conducted to compare the performance of MLE and Bayesian estimates. Conclusions: The results show that the Bayesian point estimate, the posterior mode, is more accurate than the MLE. The posterior variance is also smaller than that of MLE. Compared with the conventional maximum likelihood estimation, the Bayesian approach is more flexible when a more complex genetic model is considered.
• 355 - 364
• 10.6288/TJPH2004-23-05-03

• Link 原著 Original Article
• 失業與醫療利用Unemployment and Medical Care Utilization in Taiwan
• 蔡淑鈴、藍忠孚、李丞華、周穎政
  Shu-Ling Tsai, Chung-Fu Lan, Cheng-Hua Lee, Yiing-Jenq Chou
• 失業 ； 每人年醫療利用 ； 差異中之差異法 ； 廣義估計方程式 ； 台灣
  unemployment ; medical utilization ; difference in difference (DD) method ; generalized estimation equation (GEE) ; Taiwan
• 目標：過去之研究顯示失業與醫療利用之關係同時存在健康效應(health effect)與所得效應(income effect)，但迄今尚無定論，在台灣迄今亦無失業與醫療利用相關之實証研究。本研究之目的在了解台灣在全民健康保險制度下，失業對醫療利用上之影響，並針對特定疾病醫療利用之影響加以分析。方法：本研究為有對照組之實驗設計，定義之失業為2001年非志願性失業者共92,562人為研究對象，並選取同時期之在職者共92,443人為對照組，觀察期間為每人失業前後各一人年，以差異中之差異法(difference in difference method)與廣義估計方程式(Generalized Estimation Equation )測量。結果：研究結果顯示失業後一年西醫整體門診醫療利用變化呈下降情形，主要受呼吸道感染之醫療利用下降之影響；精神疾病之醫療利用有明顯上升之情形；另三種心血管疾病之醫療利用則在失業後無明顯影響。結論：失業對醫療利用之影響，在不同疾病上確有可能受所得降低與健康衝擊之不同程度之影響。本研究只檢驗失業對醫療利用之短期(一年)影響，至長期影響尚待後續之追蹤與監測。
  Objective: Previous research has shown that exposure to unemployment could have health effect and income effect on medical care utilization. This study examines total and five disease-specific medical care utilizations before and after exposure to involuntary unemployment under the National Health Insurance Program in Taiwan. Methods: An experimental study with control group and fixed effect model were used. Two groups of people were observed from 1999 to 2002: (1) the involuntary unemployment group (n=92,562), and (2) the control group (n=92,443). The unit of observation was person-year. In order to obtain more precise estimates and control for possible confounders, the difference-in-difference (DD) method and generalized estimation equation (GEE) approach were conducted. Results: Decrease in both ambulatory and inpatient services utilizations were observed after unemployment. In terms of disease-specific utilization, 3 important findings are identified: (1) a decrease in the ambulatory utilization for respiratory diseases has been detected after unemployment; (2) no significant change in utilization for three cardiovascular diseases has been found after unemployment; (3) an increase in utilization has been identified for mental diseases after unemployment. Conclusion: A decrease in income and health effects of unemployment on medical care utilization vary among the types of diseases. One limitation in the study that we only examined the short-term (one year) effects of unemployment on medical care utilization, so it is important in the future to further investigate the possible long-term effects of unemployment on utilization.
• 365 - 376
• 10.6288/TJPH2004-23-05-04

• Link 原著 Original Article
• 供需成本節制對健保醫療費用影響之時間序列分析Time Series Analysis of the Impact of Supply and Demand Side Cost Containment Policies on NHI Medical Expenditure
• 楊銘欽、李姣姿、邱尚志
  Ming-Chin Yang, Chiao-Tzu Lee, Shang-Jyh Chiou
• 時間序列分析 ； 全民健保 ； 部分負擔 ； 合理門診量
  Time series analysis ; NHI ; co-payment ; regressive physician payment
• 目標：本研究旨在藉由時間序列分析模式，探討1999年8月實施之新制部分負擔與2000年1月實施之醫院合理門診量的實施，對於全民健保門診人次、門診申報費用及總醫療申報費用的影響。方法：主要採用時間序列模式，以1995年3月至2001年12月的健保按月申報之使用量急醫療費用進行分析。結果：時間序列經選擇適合模式後，除門診人次外，R square都達九成以上；評估兩個重要政策介入點對時間序列趨勢之影響，其中新制部分負擔實施有遞延效應。結論：在描述性資料方面大抵與文獻結果一致，而時間序列模式在2002年的預測點估計亦與實際值接近。從介入模式分析結果發現，單純就政策介入發生該月而言，節制醫療提供者之醫院合理門診量，比節制消費者之部分負擔，對於控制醫療費用之效果較為顯著，不過一年的推估結果則有不同的效果。
  Objective: The purpose of this study was to use time series analysis methods to examine the impact on cases of ambulatory care, claims of ambulatory care and the grand total of medical claims when co-payment and regressive physician payment policies were implemented. Methods: Based on the data from the NHI from Mar. 1995 to Dec. 2001, time series models were used to formulate the time series. Results: By selecting the appropriate time series models, the R squares of these models were over 90 percent except for the model of ambulatory care cases. The two interventions including co-payment and regressive physician payment policy were used in the intervention models. The result showed that co-payment intervention had a delayed effect of one month. Conclusions: The results were similar with that of existing papers in terms of descriptive analyses. The outcomes of our models were also reliable in the point estimation in the forecast of 2002 expenditure. The outcome of intervention models found that regressive physician payment policy had a greater impact than the co-payment policy in the month when the policy was implemented, but the predication of one year using the time series models produced different results.
• 377 - 387
• 10.6288/TJPH2004-23-05-05

• Link 原著 Original Article
• 作業基礎成本法與相對值單位法之成本結構相關性比較－以牙科60項處置為例Contrasting Cost Conponents of ABC and RVU for 60 Dental Procedures
• 陳琇玲、張睿詒、戴復興
  Hsiu-Ling Chen, Ray-E Chang, Hock-Hin Tay
• 作業基礎成本法 ； 相對值單位法 ； 牙科 ； 成本
  activity-based costing (ABC) ; the relative value unit method (RVU) ; dental ; cost
• 目標：比較作業基礎成本法（the activity-based costing method, ABC）及相對值單位法（the relative value unit method, RVU）分析牙科處置所獲得結果之相關性，以提供醫院及衛生主管機關選擇成本分析方法之參考。方法：以前人利用ABC及RVU二種方法，分析牙科成本或投入資源相對值所獲得結果（ABC研究與RVU研究），探討二個研究60個可對應處置，區分牙體復形科、根管治療科、牙周病學科、口腔外科四科，其醫師成本、耗材成本、其它執業成本、總成本之Spearman’s rho相關。並且將二個研究結果分別與92年健保支付標準進行Spearman’s rho檢測。結果： ABC研究與RVU研究結果，不論在醫師成本、耗材成本、其它執業成本、或總成本四個構面，相關性均達顯著（p＜0.01）。口腔外科四個構面相關性更高，根管治療科四個構面卻均未達顯著相關。二個研究結果之各構面中，「醫師成本」與「總成本」相關性均高，其次為「其它執業成本」，「耗材成本」相關性最低。二個研究結果均分別與92年健保支付標準呈顯著且高度相關（p＜0.01）。結論：（1）ABC研究與RVU研究結果在四個構面（醫師、耗材、其它執業成本、總成本）之成本與相對值排序關係一致，尤其是醫師成本及總成本。（2）不論ABC研究或RVU研究，健保支付標準足以反應牙科處置投入資源相對性的排序關係。（3）雖然無法判定ABC與RVU的優劣，但是二個研究結果的高度相關，顯示醫療機構及衛生主管機構可以依據可投入資源多寡，以及目的不同，來選擇成本分析方法。
  Objectives: The purpose of this study was to compare the correlation of cost datas for 60 dental procedures between the activity-based costing method (ABC) and the relative value unit method (RVU). This may serve as a reference for choosing the optimum cost method for hospitals or government health departments. Methods: From previous research (ABC study and RVU study), 60 procedures from four dental specialities (Operative Dentistry, Endodontics, Periodontics, and Oral Surgery) could be found correspondingly. The correlation between two studies in terms of physicians’ cost, medical material cost, other practice cost, and the total cost were compared by Spearmen’s3 + rho. The correlation between the total cost of each of the two studies and the reimbursement given by the National Health Insurance (NHI) were also compared. Results: The cost datas of ABC and RVU studies correlated significantly with each other (p<0.01) in respect to physicians’ cost, medical material cost, other practice cost, and total cost. The costs of Oral Surgery had the best correlation of the four specialties with the lowest one being Endodontics. On the four dimensions, physicians’ cost and total cost had the best correlation. Other practice cost was second, and medical material cost was the lowest. The total cost of ABC study or RVU study was significantly correlated with the reimbursement given by NHI. Conclusions: The sequencial relationship of costs between ABC and RVU were similar, especially in terms of physicians’ cost and total cost. (2) The reimbursement given by NHI can respond to the costs of ABC study or RVU study. (3) In respect to the high correlation between two studies, though one cannot judge which one is better, we suggest hospitals or governments adopt the cost method according to the resouces which can be utilized.
• 388 - 397
• 10.6288/TJPH2004-23-05-06

• Link 原著 Original Article
• 公共衛生護理人員工作壓力感受、因應策略與壓力結果之探討—以互動型工作壓力模式為架構Work stress, Coping Strategies, and Consequences among Public Health Nurses - Based on an Interactive Model
• 李逸
  I Lee
• 公共衛生護理人員 ； 工作壓力感受 ； 因應策略 ； 壓力結果
  public health nurses ; work stress ; coping strategies ; consequences of the stress
• 目標：本研究以互動型工作壓力模式為架構，探討公共衛生護理人員之工作壓力感受、因應策略與壓力結果。方法：以郵寄問卷方式進行收案，調查樣本為北高兩市同意參與研究之衛生所護理人員共171人，獲得有效問卷167份進行資料分析。結果：研究發現（1）工作壓力感受越大者，其工作滿意度越低、身心健康狀況越受影響、離職傾向越明顯。（2）相對較廣泛使用因應策略者，其工作壓力感受與壓力結果的相關性消失了，且壓力感受對壓力結果不具預測力。（3）在較高工作壓力感受的樣本中，較廣泛使用因應策略者相對於較少使用因應策略者，在心理與身體健康狀況較不受影響，且其差異達到統計上顯著的水準。結論：使用因應策略對壓力過程的緩衝作用在本研究中獲得支持，但是其作用機制應進一步探討。建議可在職場中安排增進壓力因應策略之活動，而未來研究可朝因應策略對壓力過程之調節機制方向探討。
  Objective: using an interactive model of stress, this study investigated the relationships between perceived work stress, coping strategies and their consequences among public health nurses. Methods: A structured questionnaire was sent to public health nurses working in Taipei or Kaohsiung city who agreed to participate in this study. Among 171 voluntary subjects, 167 questionnaires were completed and returned. Results: (1) The perceived level of work stress was negatively correlated with job satisfaction and physical/mental health, and was positively correlated with turnover intention. (2) For those who adopt relatively higher level of coping strategies, the relationships between perceived work stress and outcome variables were weakened, and their perceived stress had no predictive power on stress outcomes. (3) Within high work stress samples, high-level coping adopters suffered relatively less mental and physical problems than low-level adopters showing statistical significance. Conclusions: The buffering effect of coping strategy adoptions was found in this study, but the mechanisms of the effect merit further exploration. This study suggested that activities for enhancing coping strategies can be arranged at work, and more reseach on the detaited intervention mechanisms of specific coping strategies should be made.
• 398 - 405
• 10.6288/TJPH2004-23-05-07

• Link 實務 Public Health Practice
• 整合性醫療服務經營模式對澎湖急診醫療之影響The Impact of an Integrated Delivery System on Emergency Care in Peng-Hu
• 陳家容、柯成國、連守揚、阮仲洲、黃于珊、陳昱甫、盧尚斌、李源芳
  Chia-Jong Chen, Chen-Guo Ker, Shoou-Yang Lian, Chung-Chou Juan, Yu-Shan Huang, Yu-Fu Chen, Shang-Pin Lu, Yuan-Fang Lee
• 整合式醫療服務經營模式計畫 ； 醫療保險計畫 ； 急診 ； 醫療照顧
  Integrated delivery system (IDS) ; health insurance program ; emergency ; health care
• 目標：本研究旨在探討澎湖地區急診重症醫療品質整合醫療服務經營模式計畫實施後，澎湖地區民眾在急診醫療利用情形與滿意度是否有改變。方法：本研究從健保申報資料進行相關比較，並以隨機選樣方式對澎湖本島居民進行計畫前後滿意度調查，回收率均在9成以上。以SPSS 10.0 for Windows軟體進行分析，並以描述性統計、T檢定呈現研究結果。結果：IDS計畫實施後平均每月門診急診次數由760.3次增至1117.3次（P＜0.05），而平均每月費用則約增加35.7萬元（P＜0.05）；平均急診住院次數從91.0次增為145.7次（P＜0.05），而由急診轉送住院之費用平均每月約增加127.3萬元（P＜0.05）。另外從兩次滿意度調查結果發現，受訪民眾對急診醫療的滿意度相對提高。結論：澎湖地區離島醫療及急診重症醫療品質整合醫療服務經營模式計畫實施後有助於提升急診效益及民眾滿意度，且增加當地民眾對澎湖急診醫療的信心，並減少遠送台灣本島就醫的社會成本，故持續於澎湖地區推展此計畫是有其價值的。
  Objectives: The study evaluated the changes in health services utilization and patient satisfaction following the implementation of an Integrated Delivery System (IDS) in the Peng-Hu area, starting on July 1, 2001. Methods: Using data collected from benefit claims of the Kaohsiung-Pinton Branch of National Health Insurance Bureau and community surveys conducted by the investigator, the researcher employed inferential statistics, such as Student T-test, as well as descriptive statistics in fulfilling the goals of the study. Two surveys were conducted before and after the program with a response rate>90%. Results: Following the IDS program, the average number of ambulatory emergency care incidents increased from 760.3 per month to 1117.3 per month (P<0.05) and the average cost rose to NT$357,000 (P<0.05). Similarly, the average number of hospitalized emergency care incidents increased from 91.0 per month to 145.7 per month (P<0.05) and the average cost rose to NT$1,273,000 (P<0.05). Besides, the second time the satisfaction of residents was measured, it was relatively higher than in the first survey. Conclusions: The increase in health services utilization and satisfaction levels among residents showed that the IDS program was successful. Thus, we suggest a continuance of this program is suggested.
• 406 - 411
• 10.6288/TJPH2004-23-05-08

• Link 研究紀要 Research Brief
• 台北市學齡前身心障礙兒童之醫療照護利用調查Healthcare Utilization and Barriers Assessment for Preschool Children with Disabilities in Taipei
• 林金定、林雅雯、嚴嘉楓、吳佳玲、卓妙如
  Jin-Ding Lin, Ya-Wen Lin, Chia-Feng Yen, Jia-Ling Wu, Miao-Ju Chwo
• 身心障礙 ； 身心障礙兒童 ； 醫療需求 ； 醫療利用
  disability ; healthcare utilization ; barrier ; preschool children
• 目標：探討台北市學齡前身心障礙兒童的醫療照護利用情形與所遇到的障礙。方法：針對民國89年底領有身心障礙手冊，而設籍台北市的1006名0～6歲身心障礙兒童之主要照顧者進行問卷調查，有效問卷共回收340份，回收率為33.8%。結果：過去四個月內，身心障礙兒童健保卡的平均使用格數為14.75格，有30.1%的研究對象曾到急診就醫；健保卡使用格數隨著兒童的年齡增加而減少，而需要復健治療之兒童，有較高的醫療利用；在住院與急診方面，隨著身心障礙的嚴重程度有較高的利用率。就醫障礙以主要照顧者的時間限制與醫療負擔之經濟因素為主要因素，主要照顧者期許政府優先辦理的事項以財務負擔及缺乏醫療資訊為主。結論：本研究顯示身心障礙兒童的醫療照護利用明顯的高於其他群體，突顯出對醫療照護的高度需求，相關的數據資料可供改善身心障礙兒童醫療照護之參考。
  Objectives: To assess the healthcare utilization of preschool children with disabilities, and to identify the barriers of getting access to the healthcare services. Methods: A structured questionnaire was used to measure the healthcare utilization and barriers involving 340 of the main carers of preschool children with disabilities in Taipei and the total response rate was 33.8%. Results: The mean number of physician visits was 14.75 in the previous four months, and 30.1% children had ever utilized the emergency care. Responses differed slightly in physician visits with regard to the age of children with disabilities and rehabilitation necessity. The inpatient and emergency care utilization were related to the level of disability of children with disabilities. The research findings revealed that the main barriers of healthcare services confronting the parents of children with disabilities were time and economic burden of healthcare services. Conclusions: The health needs of preschool children with disabilities were greater than the general population. To ensure their health rights, the healthcare system should be restructured to ensure the accessibility and availability for children with disabilities.
• 412 - 418
• 10.6288/TJPH2004-23-05-09

• Link 研究紀要 Research Brief
• 從健保透析申報資料定義並分析國內慢性腎衰竭病患透析情形Definition and Analysis of Patients with Chronic Dialysis from the National Health Insurance Database
• 吳肖琪、黃麟珠、雷秀麗、吳義勇
  Shiao-Chi Wu, Lee-Gyu Haung, Hsiu-li Lei, Yee-Yung Ng
• 透析 ； 腎病 ； 健保 ； 盛行率
  dialysis ; renal disease ; health insurance ; prevalence
• 目標：國內外有不同定義慢性透析的方式，本研究嘗試以健保透析申報資料，找出較佳的定義，並探討國內慢性透析盛行及發生情形。方法：利用88年加密之「門診處方醫令明細檔」中透析醫令與「門診處方及治療明細檔」、「全民健保承保人口資料檔」、「全國戶政資料檔」、及87、88年「死亡檔」等串檔後進行分析。依單月透析次數超過10次、曾在門診透析或有接受腎臟移植者、連續透析4個月、連續接受透析3個月(不管次數)、連續接受透析3個月且每個月超過4次、連續接受透析3個月且每個月超過8次及連續接受透析3個月且每個月超過10次等不同條件來定義；以列聯表呈現不同定義之差異，並計算透析盛行率及發生率。結果：慢性透析病患條件的界定以連續透析4個月(即連續透析超過3個月)或連續透析超過3個月且每月超過4次選取較佳，88年底整體慢性透析盛行率為13.0人／每萬人口、全年發生率為3.4人／每萬人口，且女性透析盛行率及發生率高於男性，以65～74歲盛行率最高。結論：未來可從健保透析申報資料，以連續透析4個月或連續透析3個月每月超過4次來作為慢性透析病患之定義。
  Objectives: There are several different definitions of patients with chronic dialysis in Taiwan and abroad. The purpose of this study was to find a better definition of patients with chronic dialysis from the claimed data of National Health Insurance. Methods: The 1999 national health insurance inpatient and outpatient medical benefit claim databases were linked with the 1998 and 1999 death files for the purposes of analysis in this study. The different definitions of patients with chronic dialysis were listed as below: dialysis treatments over 10 times per month, receiving dialysis treatment or renal transplantation, dialysis continuously over 4 months, dialysis continuously over 3 months, dialysis continuously for 3 months and over 4 times dialysis treatments per month, dialysis continuously for 3 months and over 8 times dialysis treatments per month, dialysis continuously for 3 months and over 10 times dialysis treatments per month. We used the contingency table method to compare different definitions. The prevalence and incidence rates of chronic dialysis were also described. Results: The best definition of patients with chronic dialysis was dialysis was a continuous 4 month or continuous 3 months span of time with over 4 times dialysis treatments per month. According to this defintion, the prevalence rate of chronic dialysis in 1999 was 13.0 per 10,000 population, and the incidence rate was 3.4 per 10,000 population. The distribution for prevalence and incidence by sex showed that females have a higher rate of dialysis treatment. Incidence and prevalence rates tended to increase with age, but the prevalence rate fell for the oldest age group. The largest group of prevalent patients fell between the ages of 65 to 74 years. Conclusion: We suggest that future studies related to dialysis studies could adopt the definition of receiving dialysis continuously for 4 months or continuously for 3 months at over 4 times per month from the claimed data of National Health Insurance.
• 419 - 427
• 10.6288/TJPH2004-23-05-10