全民健保醫療利用集中狀況及高、低使用者特性之探討

Concentration of Health Care Expenditures in Taiwan-Analysis of Patient's Characteristics

張鴻仁(Hong-Jen Chang) ； 黃信忠(Shin-Chung Huang) ； 蔣翠蘋(Tsui-Ping Chiang)

《台灣公共衛生雜誌》 21卷3期 (2002/06) Pp. 207-213

https://doi.org/10.6288/TJPH2002-21-03-07

摘要

目標：本研究旨在呈現醫療使用的集中狀況，並比較醫療高、低使用者在年齡結構及就醫疾病上的差異。方法：以健保局89年曾經參加健保之所有保險對象為研究對象（N＝22,161,422），本研究每人平均醫療費用為14,662元，百分位數為79.4，取接近平均數之80分位數（15,174） 為高、低使用之分界點，進行資料分析。結果：（1）醫療低使用者佔全體保險對象之80％，使用約25％的醫療費用，其中有7.7％的人全年未使用健保醫療資源；而高使用者人數佔全體保險對象之20％，則花費約75％的醫療費用，其中使用最高的１％人口，約使用全部費用的28％（2）高使用者人口結構之慢性疾病，醫療費用居首位者為腎炎相關疾病，其次為惡性腫瘤及高血壓性疾病。在低使用者方面，醫療費用則以感冒及牙科疾病等輕微疾病為主。結論：全民健保醫療利用呈現集中化，高使用者主要為老年人口、住院、慢性病及重症病患，足見健保制度確已達到照顧弱勢及風險分攤之成效。

關鍵字

全民健保 ； 年齡結構 ； 疾病分類 ； 慢性病

並列摘要

Objectives: The objective of the study was to explore the distribution of health care expenditure among enrollees of different levels of service utilization in Taiwan’s national health insurance. Methods: In 2000, 22161422 beneficiaries were entitled to receive NHI services. Claim data retrieved from the NHI database indicated that the average expenditure per person in 2000 was $NTl4,662, at the 79.4th percentile. Accordingly, the enrollees were divided into “high user” and “low user” at the 80th percentile ($NT15174). Age, types of services received and disease pattern were analyzed to compare the two groups. Results: (l) About 25% of NHI total medical expenditure in 2000 was accounted for by low users, 80% of the enrollee population, of whom 7.7% never used the services. On the contrary, for high users, being only 20% of the enrollee population, accounted for 75% of the expenditure. The top 1 % of users alone accounted for 28% of the expenditure. (2)People in the high-expenditure group are relatively older than those in the lowexpenditure group. There were more high users in the older age groups than the younger ones. (3) Most of the utilizations among high users occurred in the inpatient department and chronic conditions that required long-term services; while primary services, such as influenza and dental diseases, accounted for a large proportion of health care of low users. Conclusions: The findings of the research showed that health care expenditure was concentrated on a small proportion of the population. Age, diseases pattern, and whether or not hospitalized were factors influencing the medical expenditure of high users. The results of this study indicated that the goals of pooling the risk and providing care to the disadvantaged had been achieved through the implementation of NHI.

並列關鍵字

national health insurance ； age ； disease pattern ； chronic conditions

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