- 學位論文
全民健康保險局高屏分局無牙醫鄉民眾醫療的研究 全民健康保險局高屏分局無牙醫鄉民眾醫療的研究 全民健康保險局高屏分局無牙醫鄉民眾醫療的研究
A Study of Dental Care in Dental Resource Deficient Areas in Kao-Ping Branch of the Bureau of National Health Insurance
摘要
背景：基於健康是人的基本權力，民眾有權利要求政府照顧，政府有義務提供醫療，本研究藉以探討牙醫醫療資源缺乏區，牙醫師人力的供給情形，並了解牙醫醫療資源之醫療利用，醫療可近性。 目的1.評估2002年至2004年牙醫醫療資源缺乏地區執業及巡迴醫療試辦計畫改善方案之牙醫利用及醫師服務供給量評估。2.瞭解高屏分局「牙醫資源缺乏區」戶籍所在地投保人牙醫醫療的利用情形。3. 由電話訪談瞭解牙醫醫療資源缺乏地區執業牙醫的看法。 材料與方法︰本研究是次級資料(secondary data)的分析研究，設戶籍於「牙醫醫療資源缺乏地區」的被保險共274,679人。資料包括被保險人的基本資料及全民健康保險特約醫事服務機構門診醫療服務點數清單暨醫令清單檔，瞭解就醫人數、人次、醫療費用之利用情形等，以描述性統計分析。 結果： 1.牙醫醫療資源缺乏區的牙醫醫療利用︰執業就醫人數與巡迴醫療就醫人數比為20％︰80％，醫療費用比率執業與巡迴醫療為7%︰93%，平均就醫次數（人次/人數）高雄縣1.3、屏東縣1.8、澎湖縣1.8；醫師供給量評估︰2004年與2003年比較執業醫師申報人日成長6％、月數成長25％，以澎湖縣白沙鄉最好，巡迴醫療申報人日成長38.6％，巡醫人數成長92.1％，醫師平均每人看診日數負成長27.8％，服務對象80.7％為5–14歲學齡兒童。 2.戶籍投保人的醫療利用︰2002、2003、2004年牙醫醫療利用率（牙醫醫療資源缺乏地區就醫人數/牙科案件人數）分別為3.4％、6.5％、10.7％，2004年就醫率為（就醫人數/設籍投保人），高雄縣18％、屏東縣22％、澎湖縣33％，牙科治療平均每人醫療費用高雄縣1358元、屏東縣2051元、澎湖縣1669元，高過全國與全國偏遠地區的平均值（1181元、923元），牙科治療平均每人次醫療費用高雄縣1015元、屏東縣1162元、澎湖縣941元。齲齒材質充填兒童以銀粉充填為主、成人以樹脂充填為主。 3.電話訪談執業牙醫師看法以回饋社會，服務人群。 討論與建議︰ 無牙醫鄉醫師獎勵試辦計畫，政府使用的方法與美國政府介入公費生及提高薪資增加醫師人力供給和可近性相同，執業成效不好，巡迴醫療較好，就醫率澎湖縣達到全國值、高雄縣、屏東縣未達到，以巡迴醫療為主，戶籍投保人的牙科醫療利用率僅3.4–10.7％應加強服務，以符合「量」與「費用」的平衡。 關鍵詞：牙醫醫療資源缺乏區、牙科醫療利用。
並列摘要
Background: Based on the right of health care of the people and the obligation of medical service from the government, the study is conducted to understand the supply of dental manpower, the accessibility of dental care and the utilization of dental treatment in dental resource deficient area. Objectives: 1.To evaluate the supply and utilization of dental services from 2002 to 2004 in the project of “Improving the Experimental Plan for Medical Practice and Medical Tour in Dental Treatment Resource Deficient Area”. 2.To understand the utilization of dental treatment by the proposers domiciled in “dental treatment resource deficient area “, defined by the Bureau of National Health Insurance Kao-Ping Branch. 3.To collect opinions from dentists going service on dental resource deficient area by phone survey. Materials and Methods: The study is an analysis of secondary data. There are 274,679 insurers domiciled in dental resource deficient areas. Data used to estimate the amount of persons seeking for dental treatment (practice group and tour group) and the expenses include ID number, towns of domiciled, gender, age, health insurance cards, medical orders and treatment details. Data analysis was performed by using descriptive statistics. Results and suggestion︰ 1.For utilization of dental treatment, the ratio of practice group to tour group in patient numbers and expenses was about 20:80 and 7:93. In 2004, the average visit of each dental patient was 1.3 in Kaohsiung county (KC), 1.8 in Pingtung county (PTC) and 1.8 in Penghu county (PHC). The declared daily growth rate of dental visit was 6% in practice group and 38.6% in tour group when compared to 2003. Although the patient numbers in tour group increased 92.1% in 2004, the average service day per dentist was -27.8% in growth rate. Most of the patients (80.7%) were between age of 5 and 14. 2.For utilization of dental care, the annual demand rate (total cases in deficient area/ total cases by these insurers) in 2002, 2003 and 2004 was 3.4%, 6.5% and 10.7% respectively. For accessibility of dental care in 2004, the ratio of insurer seeking for dental treatment is 18% in KC, 22% in PTC and 33% in PHC. The expense per dental patient was 1356 NTD in KC, 2051 in PTC and 1669 in PHC. All were exceeded the national average (1181) and average (923) of whole dental resource deficient areas. The expense per visit was 1015 in KC, 1162 in PTC and 941 in PHC. The filling materials used for caries was mainly amalgam in children and resin in adults. 3.Phone survey of dentist going service in theses areas shows that service for the people and reward for the society are their main purpose. Discussion and Suggestion ： The government is using methods similar to the United State government such as state-financed program and salary raise for increasing the supply of dental manpower and the dental accessibility in dental resource deficient areas. As a whole, the practice effect is not so satisfactory when compared to medical tour .The accessibility of dental treatment in KC and PTC was under but in PHC has nearly reached the national standard (33.47%). It was mostly by tour not by practice. The demand rate was only 3.4-10.7%. I suggest that the dental treatment service needs to be enhanced in order to reach reasonable balance between its amount and expenses. Key word: Dental Treatment Resource Deficient Areas, Utilization of Dental Treatment