- 學位論文
SARS對全民健康保險牙科醫療利用影響研究
The Impact of the SARS Epidemic on the Utilization on Dental care under NHI system
摘要
背景：嚴重急性呼吸道症候群Severe Acute Respiratory Syndrome （簡稱SARS），造成醫療系統極大影響，也相對造成民眾醫療服務利用改變。由於牙科醫師服務需近距離與病患接觸，且飛沫傳染為SARS重要危險因子；本研究遂做進一步相關之探討。 研究目的：一、分析SARS疫情對牙科申報之醫療費用、醫療利用率之影響，及對各地區間、醫療服務層級間因疫情嚴重度不同的差異情形。二、瞭解牙科服務項目是否因醫療急迫性之不同而有所差異。 研究方法：利用2001至2003年間全民健康保險之牙科申報醫療點數、件數資料庫，以描述性分析、雙樣本t檢定分析、配對t檢定分析、變異數分析、複迴歸，來檢定前SARS期、SARS流行期、後SARS期及與前一年同期間之影響。 結果：1.One-way anova分析SARS流行期牙科整體醫療點數、件數週平均值均顯著減少，各層級都達顯著差異，且醫院影響普遍大於診所；對各分局間檢定分析則大部分都有顯著減少，再比較大小順序，大多是後SARS期大於前SARS期，而SARS發生期最小；由雙樣本t檢定分析，醫學中心、區域醫院、地區醫院醫療點數、件數降低20至30%，達顯著差異，而基層診所降幅較小。2.在五類醫令中雙樣本t檢定分析，除根管治療類小幅增加外，其餘都減少，且銀粉充填類降低16.38%，洗牙類降低7.45%，達顯著差異。特定醫令分類占率，以銀粉充填類下降1.72%最多，洗牙類下降0.34%次之。3.歸納牙科特定醫令類別緊急程度比較：根管治療類＞樹脂充填類＞拔牙類＞洗牙類＞銀粉充填類。 結論：由本研究證實，SARS對全民健康保險牙科醫療費用、醫療利用率、牙科服務項目間確實產生影響，而對於特定醫令類別緊急程度比較的結果，更可提供予相關單位於特殊疫情再度發生時，作為總額支付制度分配及支付標準調整之參考。
並列摘要
Background：The endemic of Severe Acute Respiratory Syndrome （SARS） had a great impact on the health care delivery system of Taiwan in the year 2003, and also affected the health care utilization of the beneficiaries of the National Health Insurance. Dentists must be in close contract with patients, and could be exposed to the risk factor of breathing the air of a SARS patient. This study was to explore the changes of utilization of the items of specific dental care and the number of visit in the endemic period of SARS. Study objective：The purpose of this study involved two tasks: 1. The difference in the utilization of dental care and the claims of dental care fees among various districts and health care providers in the endemic period of SARS 2. The study examined whether the items of specific dental care were influenced by the categories of dental care urgency. Method：The utilization of dental care and the number of visits were collected from the claims of dental care fees from the Bureau of Health Insurance in the years of 2001,2002 and 2003. Descriptive statistics ,two sample t-test, analysis of variance and multiple regression were used to investigate the relationship among the variables in the nineteen weeks of the pre-SARS period 、SARS endemic period and post- SARS period , the same period between SARS endemic period in 2003 and non- SARS endemic period in 2002. Result：1.We found that the number of visits and the dental claim fee per week decreased in the SARS endemic period. Moreover the differences were observed in all levels of dental care institutions and the NHI districts. The degree of decrease in the utilization was that the post- SARS period was greater than the pre-SARS period ,and the least in the SARS endemic period. The two sample t-test in contracted category, academic medical centers, metropolitan hospitals and local community hospitals reduced by 20 to 30%, dental clinics only a small decrease. 2.The two sample t-test in five items of specific dental care shoned a small increase in endodontic treatment, and reduction amalgam restoration 16.38%, scaling 7.45%. 3.The dental care urgent degrees were in the decreasing order of : endodontics ＞teeth composite resin restoration＞extraction＞scaling＞amalgam restoration. Conclusion：Our results showed obvious differences during the endemic period of SARS in the utilization of dental care 、the claim of dental care fees and the items of specific dental care. These results could serve as the base for a review of the global budget of dental care and fee schedule of dental care in the period of a speacific endemic disease.