【台灣醫界】新制成健篩檢項目之實證研討

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新制成健篩檢項目之實證研討.pdf

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[kwojohn]

謝謝ＭＫ大...

[lupin]

[王宏育]

Part III 剖析民眾對「成人健檢 健康加值方案」的反應

一、成人健檢「健康加值」是很好的方案。其中加強防治代謝症候群是有前瞻性與理想性的做法，並且可以節省許多醫療費用。

二、健保藥物支出每年1300億，支出代謝症候群佔很大比重，因此減少代謝症候群比重非常重要。

三、「健康加值」新方案多做一項HDL，付出的代價是從24項檢驗刪去17項，剩下8項。但16年來成人健檢都是24項，突然剩下不到原來一半的項目，因此造成病人觀感不佳。

四、實證醫學是預防保健制度建立的重要依據。但是，實證醫學是應該找台灣人的資料，而不是直接用美國人的資料。

五、新方案之篩檢項目刪除CBC與尿酸的理由都是依據美國實證醫學的資料。但是根據台灣的流行病學資料，高尿酸血症與貧血皆有很高的盛行率。男性40.6%、女性24.0%有尿酸偏高現象；女性貧血比例 12.3%；台灣海洋性貧血帶因者粗估6%，也有報告認為10%。

六、篩檢貧血，以肉眼觀察眼結膜是否可以代替CBC中的Hb、Hc t、RBC、MCV、MCH，在實際practice上令人懷疑。但是只要多加40元可恢復原被刪除17項，總共花費增加40元X 176萬人次 = 7千萬元。國民健康局100年預算為35億，衛生署100年預算為 515億。評估新增加檢驗HDL之利益，相較刪去原本17項檢驗事後帶來的risk，其實也許應該考慮 : 恢復24項檢驗 再加 HDL。

七、健保財政負擔逐年增加解決之道：努力推動防治代謝症候群，增加非處方藥(over the counter drug,OTC)現在約10%，可提高至25%。預防勝於治療，多做成人預防保健，早期篩檢，即早治療。

[現代仁醫]

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