全民健保預防保健服務使用率之分析

Utilization of preventive services of the National Health Insurance

季瑋珠(Wei-Chu Chie) ； 賴佳君(Chia-Chun Lai)

《台灣公共衛生雜誌》 20卷1期 (2001/02) Pp. 43-51

https://doi.org/10.6288/TJPH2001-20-01-06

摘要

目標：預防保健服務為全民健保的特殊設計，實施以來一直難以取得簡便而具代表性的樣本以反映各項服務的使用率，全民健保學術研究資料庫的開放使用提供了此一機會。本研究之目的在於估計1996-1997年全民健保提供之四種預防的使用率。方法：擷取1996年和1997年全民健保學術研究資料庫門診處方及治療明細檔，案件分類為預防保健服務者，依照各項服務之健保卡就醫序號，輔以健保規定服務之年齡性別條件，計算各序號出現之頻率，扣除重複申報者，乘以抽樣倍數，再除以該年各項服務對應之目標人口服務量，求得該項服務之使用率。結果：各項服務除子宮頸抹片有1%以下的重複外，均未發現重複申報。孕婦第一孕程第一次服務1996年為92.1%，1997年為86.7%，之後除第三孕程後段外均達80%以上。兒童預防保健服務以一歲內第一次為最高，1996年為39.6%，1997年為54.3%，第二次之後逐漸下降，一歲至三歲之服務使用率略有回升，1996年為38.1%，1997年為42.6%，滿三歲至四歲之服務則二年度均不到20%，而一歲內第四次與三歲之服務延遲的情況較為多見。成人預防保健40-64歲(三年一次)者二年分別為27.1%及27.9%，65歲以上(一年一次)者自1996年之14.5%上升到1997年之21.7%。子宮頸抹片(30歲以上一年一次)1996年為21.4%，1997年上升為26.9%。結論：本研究首次根據涵蓋全國之全民健保申報資料估計各項預防保健服務之使用率，發現除孕婦產前檢查使用率較高外，其餘均有待加強，使用率較低之項目，多有服務人口負荷高、支付金額低、無指引或手冊等問題，醫師與民眾認知亦為可能的影響因素，應針對這些問題加以改進以提高使用率。(台灣衛誌2001;20(1):43-51)

關鍵字

全民健保,預防保健服務

並列摘要

Objectives: The provision of preventive services is a special design in the National Health Insurance in Taiwan. However, it is very difficult to obtain a simple and representative sample to assess the utilization rates of these services since the implementation of this policy. The opening of the National Health Insurance Research Database (NHIRD) offered a good opportunity to do this assessment. Methods: We identified all claims whose case classification numbers indicated preventive services from the sampled outpatient files of the 1996 and 1997 NHIRD, counted the frequencies of utilization of each service, and removed duplication to obtain the utilization numbers. These frequencies were multiplied by the sampling fraction, and calculate the utilization rate according to the predicted service quantity of e target population. Results: Only in Pap smear we found a less than 1 % of duplication. The utilization rates of first prenatal service of the first trimester were 92.1% in 1996 and 86.7% in 1997. The utilization rates of all prenatal services remained higher than 80% until the last services of the third trimester. The utilization rates of child preventive services were high in the beginning service under age l year, 39.6% in 1996 and 54.3% in 1997, and declined thereafter. Rates raised in the service between age 1 and 3 year, 38.1 % in 1996 and 42.6% in 1997, but declined again and were less than 20% in the service after age 3 year. Delay of services was common in the fourth service at age below 1 year and the service after 3 years old. The utilization rates of adult preventive service were low: 27,1 % for 40-64 years in 1996 and 27.9% in 1997, 14.5% in 1996 and 21.7% in 1997 for 65 years and above. The utilization rates of Pap smear were 21.4% in 1996 and 26.9% in 1997. Conclusions: This is the first nationwide assessment of the utilization rates of preventive services of the National Health Insurance. The utilization rates were low except that of the prenatal services. Services with low utilization rates maybe due to high population load, low payment, and poor pamphlet provided such as guidelines and handbooks. Lacking awareness of physicians and population is also a possible cause. We suggest the Burean of the Hational Health Insurance to solve these problems to Improve the utilization rates.(Taiwan J Public Health. 2001;20(1);43-51)

並列關鍵字

National Health Insurance,preventive health services