台灣的可避免住院及其病患社經狀態

Preventable Hospitalizations in Taiwan and Patients' Socioeconomic Status

梁亞文(Yia-Wun Liang) ； 陳芬如(Fen-Ju Chen) ； 鄭瑛琳(Ying-Lin Cheng)

《台灣公共衛生雜誌》 27卷1期 (2008/02) Pp. 81-90

https://doi.org/10.6288/TJPH2008-27-01-08

摘要

目標：本研究目的在瞭解我國可避免住院之現況，並探討病患人口屬性與社經地位對可避免住院之影響。方法：本研究使用2003年「全民健康保險研究資料庫」進行次級資料分析，為一橫斷性研究。可避免住院則以美國健康照護研究及品質局(AHRQ)之16項預防品質指標加以定義。統計分析方法包括：描述性統計、卡方檢定及邏輯斯迴歸。結果：2003年台灣地區可避免住院人次達38萬餘人次，以男性居多(53.6%)平均年齡48.70歲(SD=31.18)，65歲以上所佔的比率最高(47.8%)：整體可避免住院率為15.5%，其費用達132億餘元，佔全年住院醫療費用的12.40%，每人次可避免住院醫療費用達34，541元。邏輯斯迴歸分析發現，性別、年齡、職業、所得、重大傷病、山地離島地區等因素是可避免住院的正向顯著影響因子。結論：本研究結果可知每7個住院人次中即有l人次是可避免住院、顯示基層醫療服務恐有分佈不均及服務品質不佳等問題。建議衛生主管機關在制定相關政策、分配醫療資源時，應加強分級醫療之觀念及架構的落實，並引用可避免住院之概念，定期監控各區域在門診照護品質與可近性之狀況，確保醫療資源的有效利用。

關鍵字

可近性 ； 門診照護敏感狀況 ； 社經地位 ； 全民健康保險

並列摘要

Objectives: This study aimed to explore the magnitude of ambulatory care-sensitive condition hospitalizations (ACSH) in Taiwan and identify significant individual sociodemographic characteristics associated with ACSH. Methods: Data for this study came from the 2003 National Health Insurance database. Bivariate statistical comparisons were used to test the differences between ACSH and non-ACSH groups with respect to specific sociodemographic characteristics. Logistic regression determined the relative significance of individual characteristics to ACSH. Results: Patients discharged with ACSHs were likely to be older and male. The mean age of ACSH patients was 48.70±31.18 years. Approximately 15.5% of hospitalized patients were discharged with ACSHs, which accounted for 13.2 billion patients. ACSH charges constituted 12.4% of the total hospital charges for all ages. The average cost per ACSH was $34,541. Gender, age, occupation, income, absence of a catastrophic illness, and living in a metropolitan area increased the probability of a preventable hospitalization. Conclusions: One in every seven inpatients had an ACSH, indicating that maldistribution in a primary care capacity and poor service quality may exist. Agencies seeking to enhance access to care should be familiar with and utilize the ACSH rate to evaluate the quality of the healthcare system and develop policies and programs that provide incentives to achieving a hierarchical medical care system.

並列關鍵字

Access ； ambulatory care sensitive conditions ； socioeconomic position ； National Health Insurance NHI

參考文獻

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