臺灣民眾健康照護利用的十年變化與人口及社會經濟因子之關係：可近性、醫療利用、與照護系統滿意度

臺灣即將邁向超高齡社會，醫療照護需求也隨之增加。本研究比較2011年與2021年臺灣的照護可近性、醫療利用、與照護滿意度，試圖瞭解近十年變化，並以安德森醫療利用行為模式（Andersen model of healthcare utilization）切入，檢視傾向因素、使能因素、與需求因素的影響。本研究採用「臺灣社會變遷調查」2011年與2021年的醫療組題組資料，進行不同年分樣本的比較，並各自以多變量迴歸分析不同因素對可近性、醫療利用、滿意度等指標的邊際效果。研究結果發現，十年前後比較，在生病或受傷時仍儘量避免去看醫生的比例降低，民俗療法使用率降低，自費健康檢查使用率稍微增加，但未達顯著差異；住院利用率則沒有顯著變化。此外，民眾對於西醫、住院、民俗療法的照護滿意度，在十年後的調查均有提高的現象。十年間，照護可近性的重要影響因子包括人口學變項中的年齡、社會經濟變項中的都市化程度等，其中都市化程度的影響在十年後已經呈現相反方向；醫療利用的部分，影響民俗療法與自費健康檢查的則包括人口學變項中的年齡、社會經濟變項中的婚姻狀態及家戶收入等，住院利用在2011年受到年齡、都市化程度、與家戶收入影響，但在2021年這些影響已經不顯著，最後，滿意度與教育程度有關。隨著社會人口學的變化，民眾在整體可近性、醫療利用、對照護滿意度的提升，也受到各種不同社會經濟因素的影響，改善社會經濟族群間的差異將是未來十年政策介入的重要目標。

Keywords

人口學及社會經濟因子；可近性；醫療利用；照護滿意度；健康不平等

Parallel abstracts

With Taiwan on the verge of becoming a society with population of advanced age, healthcare utilization in Taiwan has been increasing. The present study has compared access to care, healthcare utilization, and patient satisfaction with the healthcare system in Taiwan as it has evolved from 2011 to 2021. Guided by the Andersen Model of Healthcare Utilization this study analyzed data from the health module of the Taiwan Social Change Surveys for 2011 and 2021 utilizing multivariate logit regression, and thus estimated marginal effects of selected predisposing factors (demographics), enabling factors (social-economic status), and needs factors (health status) on various access, utilization, and satisfaction outcomes in both years. The study results showed that, over the past ten years, likelihood of delayed care decreased, traditional medicine use decreased, self-pay physical examination use increased (though not significantly), and hospitalization rates remained relatively stable. Results also showed that satisfaction with Western medical care, hospitalization, and traditional medicine have generally increased from 2011 to 2021. Most demographic and social-economic factors were associated with access and primary care utilization outcomes, with their effects varying between 2011 and 2021. Urbanization had an opposite effect on accessibility in 2021 compared to 2011. Demographic and social-economic factors were associated with traditional medicine use and self-pay physical examination utilization. In 2011, hospitalization was associated with age, urbanization, and household income, but their marginal effects were no longer significant in 2021. Satisfaction outcomes were associated with education level. While access, utilization, and satisfaction generally improved during the past decade, social-economic factors are still important determinants of some of those outcomes. Identifying the vulnerable population and addressing their specific needs should be the policy priority in the next ten years.