The soaring mechanic ventilator utilization under a universal health insurance in Taiwan

Cheng, Shou‐Hsia; Jan, I-Shiow; Liu, Pin-Chun

doi:10.1016/j.healthpol.2007.11.002

Cited by 20 publications

(16 citation statements)

References 18 publications

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“…Although previous studies have shown similar characteristics of multiple co-morbidities in PMV patients, these reports did not stratify patients into special clusters [1,9,24,28]. The LCA showed that the underlying co-morbidities associated with PMV could be largely classified into the major categories of heart diseases, septicaemia/shock, and COPD based on the high prevalence of each cluster.…”

Section: Discussionmentioning

confidence: 90%

“…After several revisions, this programme ultimately covered mechanical ventilator care in the following settings: ICUs (acute stage, <21 days), respiratory care centres (a subacute stage for weaning training, up to 42 days), respiratory care wards (a chronic stage or long-term care), and homecare services (a stable stage during which the patient is cared for directly by family caregivers). The rising number of patient-days for mechanical ventilation usage during 1997 to 2004 increased the financial burden of the NHI [9]. …”

Section: Introductionmentioning

confidence: 99%

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Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

Hung

Chen

et al. 2011

Critical Care

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IntroductionThe present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases.MethodsAccording to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan.ResultsThe analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock.ConclusionsPMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

Hung

Chen

et al. 2011

Critical Care

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“…During 2009, approximately 30,000 patients required PMV as recorded by the National Health Insurance (NHI) of Taiwan, which accounted for 4.76% of total NHI healthcare expenditures. This financial burden has now become one of the major threats to the sustainability of the NHI [11,12]. In our previous study, cancer patients requiring PMV account for up to 10.6% of all PMV patients [13].…”

Section: Introductionmentioning

confidence: 99%

Incidence, life expectancy and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007

Shih

Hung

et al. 2013

Critical Care

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IntroductionThis study is aimed at determining the incidence, survival rate, life expectancy, quality-adjusted life expectancy (QALE) and prognostic factors in patients with cancer in different organ systems undergoing prolonged mechanical ventilation (PMV).MethodsWe used data from the National Health Insurance Research Database of Taiwan from 1998 to 2007 and linked it with the National Mortality Registry to ascertain mortality. Subjects who received PMV, defined as having undergone mechanical ventilation continuously for longer than 21 days, were enrolled. The incidence of cancer patients requiring PMV was calculated, with the exception of patients with multiple cancers. The life expectancies and QALE of patients with different types of cancer were estimated. Quality-of-life data were taken from a sample of 142 patients who received PMV. A multivariable proportional hazards model was constructed to assess the effect of different prognostic factors, including age, gender, type of cancer, metastasis, comorbidities and hospital levels.ResultsAmong 9,011 cancer patients receiving mechanical ventilation for more than 7 days, 5,138 undergoing PMV had a median survival of 1.37 months (interquartile range [IQR], 0.50 to 4.57) and a 1-yr survival rate of 14.3% (95% confidence interval [CI], 13.3% to 15.3%). The incidence of PMV was 10.4 per 100 ICU admissions. Head and neck cancer patients seemed to survive the longest. The overall life expectancy was 1.21 years, with estimated QALE ranging from 0.17 to 0.37 quality-adjusted life years for patients with poor and partial cognition, respectively. Cancer of liver (hazard ratio [HR], 1.55; 95% CI, 1.34 to 1.78), lung (HR, 1.45; 95% CI, 1.30 to 1.41) and metastasis (HR, 1.53; 95% CI, 1.42 to 1.65) were found to predict shorter survival independently.ConclusionsCancer patients requiring PMV had poor long-term outcomes. Palliative care should be considered early in these patients, especially when metastasis has occurred.

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“…Thus, the reimbursement has resulted in a large financial burden for the NHI. During 2005, the total number of PMV patients who required respiratory care in the NHI of Taiwan reached 30,000 and accounted for 7.5% of the total NHI health-care expenditures, and this has now become one of the major threats to the sustainability of the NHI [10,11].…”

Section: Introductionmentioning

confidence: 99%

Estimation of Quality-Adjusted Life Expectancy in Patients Under Prolonged Mechanical Ventilation

et al. 2011

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The soaring mechanic ventilator utilization under a universal health insurance in Taiwan

Cited by 20 publications

References 18 publications

Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

Incidence, life expectancy and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007

Estimation of Quality-Adjusted Life Expectancy in Patients Under Prolonged Mechanical Ventilation

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