糖尿病患就醫行為對醫療利用與照護結果影響之探討

Effects of Care-Seeking Behavior on Health Service Utilization：A Study Based on Patients with Diabetes in Taiwan

周躍麟(CHAU YEUK LUN)

指導教授 ： 鄭文輝

亞洲大學/健康學院/健康管理研究所/碩士(2005年)

摘要

糖尿病是常見且重要的臨床和國民健康問題，國內糖尿病相關之醫療費用在健保支出佔約一成。本研究旨在探討糖尿病病人就醫行為對照護結果與醫療利用之影響，除了參考過去研究之外，更加強病患就醫行為的討論，依據不同病患的就醫行為情境，建構出影響糖尿病醫療費用的併發症數量、疾病嚴重度、資源可用性等因素的影響。資料來源為全民健保資料庫承保抽樣歸人檔1996-2003年各組資料，擷取ICD-9-CM前三碼為A181與250，扣除就醫次數在三次以下與保留1996年與2003年均有看診的個案，計有西醫整體就醫個案有4694人，西醫因糖尿病就醫有4669人。
本研究重要發現如下：
1. 有重複就醫的比例為93.1%，有逛醫師行為的比例為65.1%，無持續就醫的比例為50.3%，無固定醫療院所的比例為76.8%，無固定醫師的比例為91.4%。
2. 不管西醫整體或因糖尿病就醫，不良行為均使平均費用與次數增加。
3. 是否使用急診與是否使用住院兩方面，性別、疾病嚴重度與重大傷均有顯著關係。
4. 西醫整體費用與疾病嚴重度及重大傷病有顯著關係，但就醫行為方面只有逛醫師行為與持續就醫與西醫整體費用有顯著相關；西醫因糖尿病就醫費用與年齡、低收入戶、疾病嚴重度及重大傷病有顯著相關，但就醫行為方面只有逛醫師行為、持續就醫與固定醫療院所與因糖尿病就醫費用有顯著相關。
5. 西醫整體次數與性別、年齡、低收入戶、疾病嚴重度及重大傷病有顯著關係，但就醫行為只有逛醫師行為與固定醫療院所有顯著相關；西醫因糖尿病就醫次數與年齡、疾病嚴重度及重大傷病有顯著相關，各就醫行為均有顯著相關。
針對上述發現，本研究提出以下建議：
1. 建議健保局將糖尿病病人納入家庭醫師制度之優先推動對象
2. 鼓勵糖尿病病人建立持續就醫、固定醫療院所與固定醫師之習慣，以提升醫療品質，滅少醫療浪費
3. 鼓勵醫療院所建立個案管理制度
4. 發展其他的照護結果指標

關鍵字

糖尿病 ； 醫療利用 ； 就醫行為 ； 照護結果

並列摘要

Diabetes is a common and important problem in terms of clinic and population health. Medical expenditures related to diabetes represent about 10% of expenditures in Taiwan National Health Insurance. The purposes of this research were to analyze health service utilization and outcomes in different medical care seeking behavior. In addition to referring related literatures, the study pays more attention to discuss care-seeking behavior. The independent variable made by investigating the care-seeking behavior of diabetes patients. And construct and compare the path affected models of the purpose toward changes number of complication, severity of disease and usability of resource. The source of the data came from claims data of all set of sampled registry of beneficiaries of National Health Insurance from 1996 to 2003. ICD-9-CM with initial three codes as A181 or 250 were selected from the panel database. Excluded the cases go to the hospital under three times and Retained the cases in 1996 to 2003 have looked examined document. A total of 4694 persons in western medicine, and the cases because the diabetes goes see western medicine have 4669 persons were identified in the final analysis. The major results of this study were as follows:
1. 93.1% of the diabetic patients had readmitted phenomena. 65.1% of the diabetic patients had doctor shopping. 50.3% of the diabetic patients had no continuity of care. 76.8% of the diabetic patients had no regular source of care (RSOC). 91.4% of the diabetic patients had no regular doctor.
2. Total medical expenditure and utilization rate accounted by diabetic care or non-diabetic care outpatient also rise.
3. In emergency and inpatient outcomes were significantly related to the sex, severity of disease and whether or not having major illness.
4. Total medical expenditure of western medicine was significantly related to the severity of disease, whether or not having major illness, doctor shopping and continuity of care. Total medical expenditure of diabetic care were significantly related to age, lower family income, the severity of disease and whether or not having major illness, doctor shopping, continuity of care and regular source of care.
5. Total utilization rate of western medicine was significantly related to sex, age, lower family income, the severity of disease, whether or not having major illness, doctor shopping and regular source of care. Total utilization rate of diabetic care were significantly related to age, the severity of disease and whether or not having major illness and all care-seeking behavior.
Based on the results of this study, a few suggestions were proposed as the following:
1. The Bureau of National Health Insurance should set the management of diabetic as the highest priority for the National Health Insurance Family Physician Program
2. To improve the effectiveness of medical services and to control the health care cost, the Bureau of National Health Insurance should encourage patients to establish a regular source of care, regular doctor and continuity of care.
3. To use medical resources more appropriately, the Bureau of National Health Insurance should encourage provider to develop their own case management program.
4. To develop other care outcome index.

並列關鍵字

Diabetes ； Health Service Utilization ； Care-Seeking Behavior ； Outcome of Health Service

參考文獻

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