本研究旨在探討重大傷病患者與一般正常人生產力之差異，是否因為身體健康狀況、治療疾病所造成之時間成本、經濟因素而出現差異。在國內外有許多文獻探討因患病而造成患者的經濟損失，利用問卷調查估算出損失比例後與平均薪資做相乘得出生產力損失，然而使用平均損失天數與平均薪資直接相乘無法反映薪資隨年齡上升之變化，而且並不是所有患者均投入職場工作。本研究透過存活曲線觀察每個觀察期間患者的存活時間，並考量到就業機率之變化後，與該時期之平均薪資做相乘後加總得出生產力，以解決先前文獻中無法反映薪資變化以及就業機率之問題。樣本選擇方面使用透析患者作為研究對象，透析患者因腎臟受到嚴重損害導致患者必須終其一生接受透析治療，隨著治療時間拉長，對於身體造成之損害會逐漸加重，再加上長期治療所產生的醫療費用、工作損失時間對於患者來說都是沈重的負擔。資料來源採用健保資料庫所提供透析患者資料，健保資料庫涵蓋台灣百分之九十五以上之人口，為台灣末期腎臟病患者最齊全的資料庫。實證結果顯示年輕族群生產力損失為最大，隨患病年齡增加損失減少。透析患者就業機率呈現平穩狀態，並於老年階段時超越一般正常人，顯示透析患者在老年階段時的高工作意願。藉由量化生產力損失，可望能使民眾更深入瞭解到末期腎臟病對於身體健康及經濟上的負擔，進一步透過預防降低末期腎臟病之盛行率。

The purpose of this thesis was to investigate whether the difference between the productivity of catastrophic illness patients and normal human by physical health, time cost, and economic factors. There are many literatures discuss the economic burden of patients, and in previous literatures used to estimate the loss ratio of working hours by questionnaire and multiply the average income to estimate productivity loss. However, multiplying the average loss ratio and the average income directly to reflect productivity loss is biased obviously. Average income causes result overestimate because of income are influenced by seniority. To solve previous literature overestimate which could not reflect the change of income, using survival function to calculate survival time for each period, and multiply the average income of corresponding age. The dialysis patient data provided by Nation Health Insurance Research Database which covers more than 99% of the population in Taiwan, also the most complete database for patients who suffer from End-Stage Renal Disease. The empirical results show that the productivity loss of the young group is the largest, and the loss increases with the age of the disease. The loss percentage of overall ESRD patients is 34%. The loss percentage of male ESRD patients is 46%. And the loss percentage of female ESRD patients is 24%.

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