According to the data issued by WHO, the aging population is greatly increasing. It is predicted that in the year 2020, there will be altogether 30,000,000 existing cases of tumors. In other words, there are about 1,500,000,000 new cases every year, and the number of patients who die of tumors annually is about 10,000,000. The increasing rate of tumor patients is 73% in developing countries while that in developed countries is about 29%. Therefore, we can see that tumor is the number one killer in the new century. The whole world is trying hard to find better ways of treatment to predict, control and cure tumors. The statistical data shows that every five seconds there is a person who dies of tumors. In Macao, there is a person who dies of tumors every thirty hours. This shows that the tumor situation in Macao is also very serious. In recent years, the number of tumor patients is also increasing. Tumor has already been the number one killer in this enclave. At present, there are 4000 tumor patients in Macao, and the age of people suffering from cancer is decreasing. There are about 400 people who die of cancer every year, and the death age is between 30 and 60. Not only does cancer make one lose one's life, it can also bring great suffering and burden to one's family. This research adapts convenience sampling to gather information or data about tumor patients' consultation or treatment behavior. The content is divided into two parts - the first part is to inquire the patients' treatment behavior, and to try to understand the patients' needs, and situation by means of questionnaires. Moreover, it also tries to interpret the history, the development and the present system of healthcare in Macao. The second part is about policy suggestion by means of interview. The main point is to interview the professionals about health hygiene and policy making. The aim is to try to understand the social strategy on tumor treatment, to care about treatment improvement and welfare problems as well as to suggest policy or strategy for the present and future treatment. Hopefully, all these suggestions can enhance the progress of the strategy of the government, and bring out the most possible means of health care system for Macao citizens as well as to give substantial support for the tumor patients so as to match the SAR government to improve the quality of life of the Macao tumor patients. In Geneva, on the 1ˢᵗ of July, 2002, WHO announces that we should make better use of our present knowledge, and has already proved that by means of effective and economical methods, millions of tumor patients can be prevented and be treated. No matter whether a country is poor or rich, we should adapt effective methods to face and fight against tumor. However, nowadays, people pay more attention on tumor treatment than tumor prevention. The president of WHO, Dr. GH Brundtland, points out in one of the declarations that "no matter what resources a country had, a well-designed management system can help to improve the occurrence of tumor of a country and the survival situation of tumor patients." This control method can be improved or changed according to a country's economic situation and cultural customs. Generally speaking, people are not alert to have regular physical check-up. This can be a timing bomb for the government and oneself's medical expenses. After the return of Macau to China, the Macau government has undergone a medical system reform. The SAR Medical Bureau has adapted the American Leung's Consultation Company (RMLAssocitates) in 2000 to evaluate the system. On 9ᵗʰ October, 2001, the government officially announced the report 'New Millennium, New Macao - the Evaluation and Research of the Macao Medical System'. The report consists of 277 pages, and is divided into five sections. It describes in detail the present, the past and the future Macao medical system. The report also evaluates the research on the Macao medical treatment system, finance, law, and the development of Chinese and western medicine. At the same time, 215 reform suggestions are raised. On page 272, special attention is paid to the increase in medical cost. The consultation company estimated that by 2009, the cost of health care will increase to MOP 3,770,000,000 which shows the pressure brought by the aging population. On the other hand, it brings out the problem that the able bodies should pay for their own medical expenses. This drew the attention of the whole Macao population. According to the present medical system, tumor patients have the right of free transferal and free treatment outside Macao. But whether tumor patients can still have this right after the reform of the medical system, is a worrying problem for the tumor patients. Based on the research results, five analytical sections are brought out - personal data, treatment behavior of the tumor patients, the illness situation of tumor patients, medical expenses and treatment budget, and the evaluation on the government medical service and medical health care system. The result is quite close to the annual report of the 2003 of Macao tumor cases of the Macao Medical and Illness Prevention Bureau. Out the 25 tumor subjects, 28 % of the female patients have breast cancer while 24% of them have nasopharynx carcinoma. The recovery rate of these patients can be quite high if early. treatment is given. As a result, the mortality rate is low as well. Nasopharynx carcinoma is a common fatal tumor in China. The Canton region of China possesses the greatest number of nasopharnyx carcinoma patients in the world, especially in the Canton Province. Inhabitants of Cantonese speaking dialect have the highest infected rate - in fact, the highest in the world, so it is also called 'Canton Carcinoma'. The prevalent age range is between 17 and 74, that is, the average age is 42.24. The highest prevalent age range of tumor patients is between 40 and 50. 60% of these patients can survive more than ten years after the recovery. On the other hand, it is quite common that tumor patients may also have depression problem. Consequently, their quality of life is also low. The communication among family members and interpatient organization is important. The support from friends and family is the main support for tumor patient community. This can also enhance the hope and dignity of the patients. WHO declares that 1/3 of the newly discovered tumors can be prevented, and another 1/3 tumor cases can be cured if they are discovered early. The remaining 1/3 can just be treated so as to minimize the symptoms. Therefore, the interview part of the proposed strategy is based on the situation and the medical treatment of the patients. Chiefly speaking, it is about the treatment strategy of the tumor patients. It includes the financial support from the government, the treatment methods and the improvement strategy. The professional interviewees have been paying attention to the situation of the tumor patients. They have also been helping to improve the treatment methods and the social strategy. The result of the research is that people from all walks of life all agree that the government should pay attention on tumor prevention and hope that the government will build up a better treatment system with a higher quality so as to meet the demand of Macao citizens. They also hope that the management system of the two hospitals will merge and the resources should be well spread between the two hospitals instead of just stressing on the government itself. The level of the treatment should also be improved, and a basic concrete strategy should be built up. The idea that the able people should pay for their medical treatment can be brought out and discussed. On the other hand, both the civil servants and citizens are all caring for the construction of the third hospital in the outlying island. It is suggested that Tumor Prevention and Specialist Group should be erected in the Disease Prevention and Control Center so as to centralize the work of tumor prevention. As a result, early diagnosis as well as early treatment can be enhanced. It is necessary to provide suitable professional psychological counseling to the patients and their family. Support and transferal services are also essential. To know more about social support can help to improve the quality of life of the patients. Furthermore, the Macao SAR government is going to promote the bill of medical treatment and health care financing system. It is a very important and sensitive issue. Due to the aging population and the increase in the cost of government medical treatment, the gathered-finance system is necessary. People from all walks of life all agree that before the establishment of any strategies, it is necessary to gather public views. Now, it is the right time to gather information from all these aspects to improve the net of free-medical treatment. First of all, we can adapt the different levels of medical subsidies or bring in medical insurance system for every citizen so as to make the best use of the resources of the government. Every one must pass through the path of birth, aging, illness, and death, so health care has naturally become an important issue for every government to handle. There are a lot of problems in the Macao health care system. Generally, the inhabitants care a lot about medical treatment and medical technology while the government pays more attention on the reasonable use of medical resources and the building up of confidence in medical treatment among the public. All these have become the important point of the government policy. Although there is a difference from the point of view between the government and the public, both sides carry the same problem. Hopefully, it is necessary for both the government and the non-government organization to work together so as to develop and study other aspects of tumors and to investigate the inter-relation between the social welfare on tumor patients and Macao medical health care reform. If a reasonable, long-term medical system can be set up at an early stage, and to ensure that every improved item can have reasonable resources in addition to other necessary strategies, then all the passive strategies can be changed to active ones. If only with reasonable medical improvement, the pressure of aging can be changed to a better medical system with better treatment. This interaction may lead us to a healthier and more progressive society, thus hoping to raise the attention of the public on tumors. Keywords: Tumor Patients. Medical Seeking. Healthcare Reform. Health care financing

根據世界衛生組織的資料顯示,隨著人口老化趨勢加劇,預期到二零二零年,全球將有腫瘤(又稱癌症)現患病例三千萬宗,每年新發病將達一千五百萬宗;每年死亡病例一千萬人;腫瘤病人總數,在發展中國家將增長百分之七十三, 而在發達國家將增長百分之二十九,可見癌症正成為新世紀人類的第一號殺手。 面對癌魔肆虐,全球正積極尋求更新、更有效的防治方法,來預防、控制和治愈癌症。統計資料顯示在全球每五秒便有一人因癌症死亡,而在澳門則約每三十小時便有一人因癌症死亡,這反映澳門的情況亦很嚴重,近年來,澳門患有惡性腫 瘤疾病之人數也不斷上升,癌症已高居十大死因之首,現時全澳有四千多人患上癌症,而病發年齡更趨向年輕化,每年死亡人數約四百多人,死亡年齡多為三十至六十歲間,表示了其年齡層及死亡率。癌症不但令人失去生命,同時也給患者 和家庭帶來深切的痛苦和沉重的負擔。本研究用立意採樣法,以會談法收集資料對癌症病患者的就醫行為和了解。內容分為兩部分,一是病人的問卷調查,調查訪談癌症患者的就醫行為,瞭解病患的狀況及需要;另外闡述了衛生保健制度歷史的發展和現行的制度。二是有關政策建議的訪談,主要訪談醫療衛生及政策決策方面的專業工作人員,目的是瞭解今後對癌症治療的社會策略,關注澳門的醫療門醫療改革及社會福利問題,並為今後提出各種建議。目的是促進政府決策進程,為澳門市民的未來提供在財政上最可行的衛生保健計劃,給癌症病患者給予實質性的支持,以配合特區政府改善本澳癌病患者的生活素質。 2002年7月1日世界衛生組織(WHO)在日內瓦宣佈,更好的利用現有的知識和已經證明經濟有效的方法每年將能夠使數以百萬計的癌症患者得到預防和治療。無論是窮國,還是富國,都應該採取有效措施面對癌症,但是現在人們往往過多的關注癌症的治療,而不是預防。WHO 總幹事 Dr. GH Brundtland 在一份聲明中指出:“不管一個國家的資源情況如何,一個設計合理,管理良好的計劃能夠有效改善該國的癌症發生情況,以及癌症患者的生存狀況。”這一控制計劃可以根據國家的社會經濟狀況及文化傳統進行改變。但一般人對定期身體檢查的意識薄弱,為政府及個人未來的醫療開支帶來計時炸彈。回歸後,澳門特別行政區衛生局為了對澳門衛生醫療體制進行改革,於2000年聘用了美國的梁氏顧問有限公司,就該體制進行研究和評估,並於2001年10月9日正式向外公佈名為<<新千年、新澳門——澳門衛生體制的研究與評估>>報告書。該報告書長達277 頁,分為5個章節,詳述了澳門醫療衛生體系的過去、現在與將來,並且對澳門醫療系統的醫療、財務、法律、中西醫的發展等方面進行研究和評估,同時提出了215項改革的建議。在第272頁中,針對醫療成本增加,顧問公司估算至2009 年,衛生保健成本將增至37億7千多萬,提到了人口老化對醫療保健帶來的壓力。另一方面也提及到『能者自付』的問題,引起了全澳市民的關注,按目前醫療體制癌症病患者享有轉介及往外就醫的免費醫療服務,而醫療體制進行改革後是否仍享有此優惠,一直是癌症病患者所憂慮,本研究有關研究結果按個人基本資料、 癌症病患者的就醫行為、癌症患病情況、個人醫療預算及支付情況、對政府衛生服務衛生體系的評價五大部份來分析。所得出結果和澳門衛生局疾病預防控制中心公報的《澳門癌症登記年報二零零三》之年報數據頗接近。本次對象25位受訪者癌症類別比例中患女性乳癌有28%,鼻咽癌有24%。發現早期發現乳癌和鼻咽癌的病患者治癒率較高,死亡率卻相對較低。鼻咽癌在中國是一種常見的惡性腫瘤,中國的華南地區是全世界鼻咽癌的高發區,尤其在廣東省,講廣州方言的居民其發病率十分之高,竟居世界之首,所以又稱為“廣東癌”(Canton Carcinoma)。 其發病年齡由17歲至74歲,平均為 42.24歲;可看到平均年齡在40-50歲癌症的發病率最高,癌病癒後超過10年以上者有60%,另一方面,發現癌症病人患上抑鬱症的情況甚為普遍,而相應地他們的生活質素亦較差,更體會到家人之間溝通及病人互助組織的重要性,發現家人和朋友的支持為癌症病人社會支持的主要 來源,更可增進病患對生活的期望及提升自尊。WHO 宣稱,有1/3的新發癌症病 例是可以預防的,另1/3的病例如果早期發現則可得到有效治療。剩下的1/3 病例 只能採取姑息治療,減輕症狀。 因此有關政策建議的訪談部份是根據癌症病患的狀況初步調查和病人治療之基本需求來探討,主要涉及澳門癌症患者的治療策略,包括政府的資金投入、對癌症患者的治療措施及其改進等問題。受訪者都是一直關注本地癌症病人的現況、協助改進對癌症患者的治療措施及社會策略專業的角度的人士。研究發現, 社會各階層都認同特區政府應積極重視癌症的預防,齊盼特區政府建高效高質醫療制度,回應市民需求,祈望打破兩間醫院各自為政的陋習,扭轉資源過度集中公立醫院的策略,努力提升本澳醫療水平,制訂具體政策加強基層醫療護理配合醫改「能者自付」可以商權。另一方面, 官民都齊關注離島興建第三家醫院的可行性。建議在疾病預防和控制中心(CDC)內設立澳門腫瘤防治研究辦公室或專職小組,統一協調全澳腫瘤的防治工作,進一步提高腫瘤的早期診斷和早期治療的專業水平,認為有必要為病人及其家屬提供各種適當的專業心理輔導,支援項目及轉介服務,意識到社會支持會使癌症病患的生活品質更好。另外特區政府明年將推出醫療融資制度的諮詢方案,雖然是“非常重要但又非常敏感的課題”。基於人口老齡化、政府醫療成本增加,醫療融資制度是有必要性,各界認同政策制訂前需廣泛諮民意,吸納社會各界人士不同的意見,現時也是適當時候開展這方面的深入探討,改良免費醫療網,可嘗試先採用分級醫療津貼或引入全民醫療保險等制度,達到善用政府資源的目標。 生老病死是人生必經過程,醫療衛生政策自然成為每個政府的主要政務之一。澳門醫療衛生存在不少問題,在一般居民層面,最關心醫療福利與醫療技術; 政府層面,要解決醫療資源的合理運用,以及建立起大眾對本地醫療的信心,這些已成施政的重點。在醫療衛生上,政府的關注與民間的訴求,都是相同的問題, 只是角度有差異而已。期盼政府與非政府組織携手合作,能陸續開展其他癌症領域的研究,探討政府照顧癌症病患者的社會福利服務與澳門醫療改革的相互動關 係是有必要性的。若及早制定一個合理的,可長期運行的醫療衛生改革制度,確保各項改革項目都會透過合适的機制而獲得所需的資源,加上其他配套措施,應可以化被動為主動,只要改革得當,可將醫療融資的壓力,透過醫療改革化為完善制度和提高醫療服務水平的動力,這個互動關係,將有可能帶領我們走進一個健康進步的社會,更希望籍此喚起各界對癌症的關注。 關鍵詞:腫瘤(癌症)病患 就醫行為 醫療改革 醫療融資