農村醫療需求之調查研究第I報：農村醫療行為、疾病型態，醫療費用以及參加預付醫療保險制度意願之初步探討

A Survey of the Demands for Medical Care in Rural Area I: A Preliminary Study of the Medica Behavior, Morbidity Patterns, Medical Expenditures and the Willingness to Pay for Prepaid Health Insurance

張永源(Yong-Yuan Chang) ； 張博雅(Po-Ya Chang) ； 張坤崗(Kung-Kong Chang) ； 謝獻臣(Hsien-Chen Hsieh) ； 王金茂(Chin-Mao Wang)

《中華民國公共衛生學會雜誌》 4期 (1984/12) Pp. 86-105

https://doi.org/10.6288/JNPHARC1984-04-01-09

摘要

為探討農村地區居民的醫療需求，特選定屏東縣高樹鄉，從民國71年8月30日至9月8日，以多段、系統隨機抽樣方法，共計調查l,008戶（佔抽樣家戶之98.25%)，完成個人健康檢查2,834人（佔抽樣健康人數之71.31%）。調查結果如下：
1. 未加入健康保險家戶佔89.98%，而最近一月內184位病患中未加入健康體檢者佔95.10%。
2. 家戶自覺有病最常使用的求醫方式是找西醫，佔71.66%；其次是至西藥房購買成鷓，佔23.13%。家戶社會經濟地位愈高者，找西醫看病的比例也愈高。
3. 家戶在本鄉平均每看一次病或買一次藥花費約153元，至外地屏東地區看病之平均花費是214元，顯著高於在本鄉之花費（不包括來回之旅費）；其他如至高雄及高屏以外地區看病之花費也高於本鄉及屏東。
4. 病患一月內求醫地點以選譯診所最多，佔44.56%；其次是醫院，佔29.35%。平均每人一月內求醫次數以中醫（含中藥房）最多，3.6次；其次是醫院、診所，各為3次。平均每人每次求醫所花時間以至醫院看病最久，平均2.78小時；其次是至診所，平均2.39小時。平均每人每次求醫費用，以醫院最貴，400元／次；其次是中醫，300元／次；再其次是診所，180元／次；西藥房是70元／次。
5. 平均每人每日之住院費用是4,500元；每次平均之住院時間為9.5天。最近一月內婦女生育場所以在醫院最多，佔43.10%；其次是在他鄉診所，佔20.68%。生育費用以3,000至6,000元／次的比例最高，佔48.28%；其次是3,000元以下，佔36.21%。
6. 最近一月內患病之184位居民，以罹患循環器系疾病佔第一位(19.02%)，消化器系疾病佔第2位(17.93%)；呼吸器系疾病佔第3位(17.39%)。測量2,157位15歲以上居民血壓之結果，發現高血壓之罹急率為15.72%。若將長期在外求學與年輕工作者也一併考應在內，則實際15歲以上高血壓之羅忠率應略低於15.72%。經年齡標準化後，男性15歲以上高血壓之罹息率為11.29%，女性為10.62%。
7. 以預付健康保險方式，每戶每人每月固定斟收保險費100元，而願意加入在本鄉新設置醫療單位門診的家戶佔71.43%；如固定收保險費200元，顯意加入新醫療單位門診與住院的家戶佔51.89%。
8. 家戶各項收入與支虫調查結果，平均每戶每人每年收入為32,692元，支出為25,138元，比行政院主計處71年統計平均農家每人所得60,003元，支出30,953元及台灣省家庭收支調查報告平均每人每年所得44,949元，支出26,928元要低。醫療保健費用支出，每戶每年約6,000元，平均每人約1,154元，佔總消費支出的4.59%，此數字比台灣省家庭收支調查報告平冷每人醫療保健支出1,425元，也要低些。

並列摘要

In order to study the demands for medical care in rural area, a questionnaire-interviewed survey was undertaken in Kao-Hsu Hsiang, Ping-Tung county with multi-stage and systematic random sampling method. A total of 1,008 households were surveyed and interviewed, and 2,834 individuals' health exams were completed. The results of the interviewed survey were summarized as followings
1. The % of the households not covered by health insurance was 89.98, and in 184 sick persons within one month of surveying period, 95.10% were not covered in health insurance.
2. 71.66% of households went to see modern physicians when they were selfawared of illnes, which was the most common way used for seeking medical care; 23.13% of the households went to drug store for medication was the second in frequency. The families with higher socioeconomic status had high frequencies of usuage for seeing a modern physician.
3. The average medical expenditures spent on medical care per person each' time by the households was NT $ 153 in local area, but the average medical expenditures spent was WT $ 214 in Ping-Tung area, which was significantly higher than that in local area, (The medical expenditures did not include round traveling fees), and the average medical expenditures spent in kaohsiung and other areas except local and Ping-Tung areas were also higher than that in local area.
4. About 44.56% of the sick individuals sought medical care within one month of surveyed period in clinics, which were the most frequent places selected for medical care. Seeking medical care in hospitals were the second, about 29.35%. The median frequencies of seeking medical care per person within one month in herb medication was 3.6 times; three times respectively in hospital and clinic, were the second. The median time costs for seeking medical care in hospital were the longest, 2.78 hours per person each time; in clinic were the second, the median time costs in clinic were 2.39 hours per person each time. The median medical expenditure per person each time, hospital was the most expensive, NT $ 400; herb medication was the second. NT $ 300, and then the less were clinic and drug store, NT $ 180 and NT $ 70 respectively.
5. The median hospital stay expenditures per person per day was NT $ 4,500 the median hospital day was 9.5 days per hospital stay. The most frequent birth place of the women in child rearing age within one month of the surveyed period was in hospital, abaut 43.10% to all birth places. Birth in clinic was the second, about 20.68% to all birth places. The highest proportion of the birth expenditures was between NT $ 3,000-6,000/perbirth, about 48.28%; birth expenditures below NT $ 3,000/per birth was the second, about 36.21%.
6. The 184 individuals who were sick within one month during the surveyed period revealed illness of circulatory system was the most common in all illnesses which they had been attacked. (19.02%); illness of gastrointestinal system was the second (17.93%); and illness of respiratory system was the third (17.39%). The morbidity rate of hypertension in 2,157 inhabitants. aged above 15 years old was 15.72% The actural morbidity rate of hypertension would be slightly less than 15.72% after including the young inhabitants of long term schooling and working in urban areas.
7. If the insurance premium in prepaid form of group pratice was defined NT $ 100 per capita per month, then the households had the willingness to enroll in OPD medical care of the new medical care unit set up by Kaohsiung medical college affiliated hospital in Kao-Hsu Hsiang was 71.43% to all households surveyed. If the insurance premium in prepaid was defined in NT$ 200, the willingness of the households that could be served for medical care in OPD and hospital stay was 51.89% to all households surveyed.