影響住院病患跨區利用之因素

Cross-Region Hospitalization Behavior and Its Related Factors in Taiwan

林維娟(Wei-Chuan Lin) ； 張鴻仁(Hong-Jen Chang) ； 王本仁(Pen-Jen Wang) ； 周穎政(Ying-Jeng Chou) ； 李丞華(Cheng-Hua Lee)

《台灣公共衛生雜誌》 23卷6期 (2004/12) Pp. 453-461

https://doi.org/10.6288/TJPH2004-23-06-05

摘要

本研究的目的有兩項，第一為描述台灣地區住院病患跨越醫療區之利用情形；第二為探討個人特質、疾病特性與醫療資源等三項因素對跨區住院利用之影響。方法：本研究利用國家衛生研究院提供之2000年保險對象個人歸戶資料檔，並透過中央健康保險局數據中心協助，進行住診明細檔、醫事機構檔、重大傷病檔及戶籍資料檔等檔案串聯，共完成89,814名具全國代表性樣本為分析對象。本研究以病患戶籍地與其住院醫院所在地是否為相同醫療區，判斷是否跨區住院，並進一步對病患個人特質、疾病特性與地區醫療資源與跨區住院之間關係進行對數迴歸分析。結果：西元2000年內台灣民眾住院人次有21%為跨越醫療區住院，跨區住院比例以雲林醫療區57%爲最高，南投醫療區49%居次，而台北醫療區8%及高雄醫療區9%為最低。對數複迴歸分析顯示四歲以下幼童、高薪資所得者、手術病患、癌症及精神病等重大傷病患者，以及居住在醫師及醫院病床數較少之醫療區的民眾，均有顯著較高比例之跨區住院利用。結論：影響住院病患跨區醫療利用的因素，除了地區醫療資源外，病患個人特質及病情因素均是重要因素，未來醫療資源地區規則須進一步重視民眾人特質及疾病特性。

關鍵字

跨區利用 ； 住院服務 ； 全民健保

並列摘要

The objectives of this study were to describe the utilization pattern of patients seeking hospitalization services outside their medical regions and to explore factors influencing cross-regional hospitalization behavior. Method: This study adopted the National Health Insurance enrollment and claims data of the year 2000 provided by the National Health Research Institute. A representative sample of 89,814 beneficiaries was analyzed. This study identified cross-regional hospitalization by comparing patients' residential locations and the locations of the hospitals they were admitted to. Multivaraite logistic regressions were used. Results: For the year 2000, about 21% of hospitalized patients were from medical regions outside the regions of the hospital that they were admitted to. The highest cross-regional hospitalization rates were observed in Yunlin County (57%) and Nantou (49%). The lowest rates were observed in Taipei (8%) and Kaohsiung (9%). Multivariate results showed that children under the age of four, high-incomer individuals, surgical patients, cancer patients, the mentally ill, other catastrophic illness patients, and citizens residing in areas with poorer medical resources had higher cross-region hospitalization rates. Conclusion: It was not only the sufficiency of medical resources that had a significant influence on cross-region hospitalization, but also the patient's personal characteristics and the attributes of disease. The planning and allocation of future medical resource should take patient characteristics and the attributes of their diseases into consideration.

並列關鍵字

Cross-region utilization ； inpatient services ； national health insurance

參考文獻

陳珮青、楊銘欽、江東亮、鄭守夏(2003)。病人跨區住院與醫療區資源分布之探討。中華衛誌。22，27-32。

American Academy of Pediatrics(2000).(Consensus report for regionalization of services for critically ill or injured children).

Bode MM,O`Shea TM,Metzguer KR,Stiles AD(2001).(Perinatal regionalization and neonatal mortality in North Carolina, 1968-1994).

Chang RK,Klitzner TS(2002).Can regionalization decrease the number of deaths for children who undergo cardiac surgery?.(A theoretical analysis. Pediatrics).

Gessner BD,Muth PT(2001).(Perinatal care regionalization and low birth weight infant mortality rates in Alaska).