智能障礙者往往比常人需要更多的醫療照護,冀望透過早期療育及早發現及早治療,使之獲得完善的醫療服務。有鑒於國內早期療育資源分佈協調整合不易,期望透過早期療育的議題研究,對智能障礙兒童現況及影響就醫的選擇有更進一步了解。本研究利用全民健保之門診申報資料為資料來源,以2000年至2007年智能障礙兒童早期療育分別探討傾向因素、能用因素、需要因素對醫療資源利用情形之影響。本研究之重要結果如下: 一、傾向因素:性別對智能障礙早期療育門診醫療服務費用無明顯差異;但早期療育門診就醫次數會受到性別差異的影響,男童就醫次數略高於女童就醫次數。 二、能用因素:投保分區及都市化程度對智能障礙兒童早期療育門診醫療服務費用無明顯差異;但門診就醫次數卻會造成影響,越為繁華地帶就醫次數均高於鄉村地帶就醫次數。就醫場所層級別會影響門診醫療服務費用及門診就醫次數,層級別較高醫療服務費用會較高;層級別較低就醫次數會較多。 三、需要因素:智能障礙嚴重程度會影響智能障礙兒童早期療育門診醫療服務費用與門診就醫次數,當障礙程度處於越為嚴重的情況下,越會增加醫療服務費用及就醫次數。智能障礙兒童早期療育有發展遲緩者醫療服務費用及就醫次數均高於無發展遲緩者;智能障礙兒童早期療育有重大傷病者醫療服務費用及就醫次數均高於無重大傷病者。 早期療育可幫助發展遲緩兒童透過治療恢復到正常兒童階段,大部分發展遲緩兒童都由家長自行發現或就醫時才獲知,但須經由醫療院所進行通報後才轉介。有鑑於健全的醫療體系,擁有健康是基本權益,透過本研究期望提醒政府相關單位注意,進而幫助更多的智能障礙發展遲緩兒童。
Those with intellectual disabilities tend to need more medical care than normal people, and it is hoped that they can obtain comprehensive medical care through early intervention, diagnosis, and treatment. A retrospect study was employed to analyze the condition and influence factors of early intervention utilization of children with intellectual disabilities. The Anderson’s stage I behavioral model of health service and two National Health Insurance databases, ambulatory care expenditures by visits records and details of ambulatory care orders records, of children with intellectual disabilities between 2000 and 2007 were used to explore the usage of medical resources. The important results of this study are as follows: 1.The predisposing component : Gender does not show a significant difference in early intervention outpatient medical service costs for intellectual disabilities. However, early intervention outpatient hospital visits are affected by gender differences, with more hospital visits for boys than for girls. 2.The enabling component : Insurance district and urbanization do not show a significant difference in early intervention outpatient medical service costs for children with intellectual disabilities. However, these do cause a difference in outpatient hospital visits, since the more prosperous areas show more hospital visits than in rural areas. Level of medical treatment site would influence outpatient medical service costs and outpatient hospital visits; higher the level, higher the medical service costs; lower the level, more hospital visits. 3.The need component : The seriousness of intellectual disabilities would influence early intervention outpatient and medical service costs and visits by children with intellectual disabilities. The more serious the disability, the greater medical service fees and medical visits. In early intervention for children with intellectual disabilities, those with developmental slowness have higher medical service costs and hospital visits are higher than those without developmental slowness. For children with intellectual disabilities early intervention for major injuries or disorders, their medical service costs and hospital visits are higher than those without major injuries or disorders. Most children with developmental delay are discovered by parents or notified upon medical diagnosis, but they have to be transferred into early intervention system after notification by hospitals. Since in a comprehensive medical system, the possession of health is a basic right, it is hoped that this study can remind related departments to take note of helping more children with developmental delay and mental disabilities by eliminating the health disparity.
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