全民健保對健康差距之影響－以平均餘命為測量

Changes in Health Disparity after Introduction of National Health Insurance: Measurement on Life Expectancy

吳宛蕙(Wan-Hui Wu) ； 楊長興(Chiang-Hsing Yang)

《台灣公共衛生雜誌》 26卷3期 (2007/06) Pp. 196-207

https://doi.org/10.6288/TJPH2007-26-03-04

摘要

目標：探討全民健保是否有助於改善男性、女性最高與最低都市化，以及最高與中等都市化程度民眾平均餘命之差距。方法：以1987至2003年為研究期間，使用內政部之人口資料檔及衛生署之死因資料檔，計算出各都市化程度民眾的平均餘命後，採用Box及Tiao的時間數列介入分析，比較全民健保介入民眾平均餘命差距之影響評估。結果：全民健保實施後，並沒有顯著降低最高、最低都市化位階民眾平均餘命的差距，但是男性最高、中等都市化位階65歲平均餘命差距，以及女性最高、中等都市化位階0歲、5歲、65歲平均餘命差距皆有顯著性的縮小。結論：全民健保的實施對於民眾的健康有正向的改善，城鄉間女性健康差距較男性小，同時對於最高、中等都市化位階平均餘命差距改善程度優於最高、最低都市化位階平均餘命差距，特別是老年人的部份，但是最高、最低都市化位階民眾平均餘命的差距並沒有顯著性的縮小，因此未來應持續推動最低都市化位階地區民眾婦女保健、產前照護、環境改善及教育提升，使偏遠地區民眾得以獲得適當照顧，進而提升偏遠地區民眾平均餘命，以縮短城鄉間平均餘命的差距。

關鍵字

全民健保 ； 平均餘命 ； 健康差距 ； 都市化 ； 時間數列

並列摘要

Objectives: To examine whether National Health Insurance has narrowed the gap of life expectancy between levels of urbanization. Methods: For the period from 1987 to 2003, population data were was obtained from the Taiwan-Fuchien Demographic Fact Book, and cause of death information was obtained from the Department of Health. Life expectancy for residents was transformed to mortality series, and the event intervention analysis by Box and Tiao was employed to compare the disparities in life expectancy among the resident groups. Results: After the implementation of national health insurance in Taiwan, the gap in life expectancy between residents living in areas of the highest and those living in the lowest levels of urbanization was not statistically significantly reduced. For men at age 65, between areas of the highest and the middle levels of urbanization, the lifespan gap was significantly reduced. For females at birth, age 5, and 65, the gap between areas of the highest and middle levels of urbanization was also significantly reduced. Conclusions: Implementation of national health insurance was associated with reduction of health disparities for both genders, although seeming to be more apparent for females than males. The improvement of the gap in life expectancy between residents living in the areas of the highest and middle levels of urbanization was larger than that between the areas of the highest and lowest levels of urbanization, especially for senior citizens. In order to ensure health equity for all citizens, more resources need to be allocated for women's health care, prenatal care, and environmental protection and education in remote areas.

並列關鍵字

National Health Insurance ； life expectancy ； health disparity ； urbanization ； Box and Tiao's event intervention analysis

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