全民健保制度下三十五歲以上保險對象牙科門診利用及其相關因素之研究

The Utilization of Dental Care and its Related Factors among the Insurants Aged above 35 under Taiwan National Health Insurance System

柯靜芬(Ching-Fen Ko)

指導教授 ： 嚴雅音

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00118

摘要

中文摘要
背景：隨著全民健保普遍接受，牙科保險給付提昇民眾牙科利用可近性。但現階段針對全民健保制度下保險對象實際牙科利用需求狀態之描述，非常有限。研究目的為探討個人特質：性別、年齡別、投保金額、投保類別；投保地點：投保都市化別、投保分局別；就醫地點：都市化程度別、健保分局別等分布狀況與牙科利用型態的相關性。
方法：資料採用國家衛生研究院提供之2004年全民保健保資料庫。分析具全國代表性之承保抽樣歸人檔，串聯承保資料檔、門診處方及治療明細檔、門診處方醫令明細檔等資料，經更正後共得35歲以上仍在保的個案96,406位。最後以對數迴歸分析我國35歲以上保險對象牙科利用及其相關影響因素。
結果：顯示35歲以上有牙科利用占32.8%，其中被保險人占33.2%，眷屬占31.3%。針對這群保險對象有利用者分析發現：年齡35-44歲者占36.7%、女性占35.4%，投保金額≧40001元者占44.4%、第一類固定雇主投保者占38.1%、投保院轄市者占37.8%、投保台北分局者占36.6%有較高的利用率。
經對數迴歸分析，影響牙科利用因素為身分別、年齡、性別、投保金額等。控制其他因素後以女性、年齡45-54歲、投保健保局中區分局、投保金額為≧40000元者牙科利用最顯著。在預防性牙科處置中保險對象以投保金額≧40000元者顯著洗牙較多；治療性牙科處置中拔牙以投保第五類低收入者及就醫地點為健保局東區分局與就醫都市化別為鄉層級者影響因素最顯著；投保第二類職業工會者利用較多的根管治療及髓腔開擴處置；牙體復形以女性利用較多。
結論：健保實施後35歲以上第一類保險對象與被保險人身分牙科利用率較高，且以女性、第一類被保險人、投保金額40000元以上者較傾向預防性牙科處置。治療性牙科處置以鎮及鄉層級地區利用較高。此研究結果發現國內成年人牙科利用普遍低，建議應加強此群人口腔保健教育，尤其對鎮及鄉地區的民眾更應鼓勵其定期口腔檢查，以促進其全身健康。
關鍵字：牙科;牙科利用;牙科看診;牙科保險;成年人

關鍵字

牙科 ； 牙科利用 ； 牙科看診 ； 牙科保險 ； 成年人

並列摘要

Abstract
Background: With the general acceptance of the Taiwan National Health Insurance, dental insurance coverage gradually improved dental accessibility. However, there were limited literatures regarding utilization of dental care for insured people under the National Health Insurance in present stage. The purpose of our study was therefore to understand the relationship between types of dental utilization and individual background characteristics (e.g. gender, age, amount of insurance coverage, category of insurance). Other factors associated with dental care utilization such as place of insurance and place of dental visit were also being discussed.
Methods: The used dataset of the National Health Insurance Research in 2004 was provided by the National Health Research Institutes (NHRI).Overall, there were 96,406 aged of 35 years and older insured adults. Data was obtained from Registry for beneficiaries, Ambulatory care expenditures by visits and details of ambulatory care orders. Logistic regression analysis was performed to explore dental care utilization and its related factors.
Results: Our study showed that the utilization of dental care among aged 35 and over was 32.8%, including insured (33.2%) and dependant (31.3%). After controlling for other confounding factors, dental care utilization was significantly higher in female, aged 45-54, Insured Payroll-related Amount≧$40000 and insured at Central Branch in Bureau of National Health Insurance. In preventive dental care use, the highly significant factor associated with dental scaling was Insured Payroll-related Amount ≧$40000. In therapy dental care use, the significant factors associated with tooth extraction were low income beneficiaries, dental visits at Eastern Branch in Bureau of National Health Insurance and in towns. Moreover, the treatments of endodontic and open chamber are significantly associated with beneficiary Category two, whereas operative dentistry is more significant in female.
Conclusion: Overall, the utilization of dental care among beneficiaries Category 1 and insured aged 35 and over was higher than others. The present study showed more preventive dental care use in female, insured among Category 1, and insurance premiums more than NT $40,000, whereas more therapy dental care use was found in contryside. In general, the lower utilization of dental care in Taiwanese adults, in particular those living in more rural areas, suggested that providing effective oral health education and encouraging regular dental check-up should target those population in order to improve their general health.

Keywords: Dental; Dental care utilization; Dental visit; Dental insurance; Taiwanese adults

並列關鍵字

Dental ； Dental care utilization ； Dental visit ； Dental insurance ； Taiwanese adults

參考文獻

參考文獻

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