全民健康保險於兒童牙科門診醫療利用之探討
--以高屏分局為例

摘要背景：口腔健康狀況及牙科醫療利用在族群間及城鄉間有差異性，且0-12歲是人體生長發展、良好健康行為的養成，及恆齒齒列生長發育的重要時期，目前針對兒童牙科門診醫療利用去探討城鄉差異及牙科門診醫療耗用情形少見，故本研究以高屏分局健保資料欲達如下目的。研究目的：（1）比較兒童(12歲以下) 與非兒童(12歲以上)牙醫門診資源耗用情形。（2）探討高屏分局轄內不同縣市、鄉鎮別12歲以下兒童牙醫門診醫療利用及其差異。（3）瞭解兒童牙齒填補的城鄉差距與填補材料的使用差異。研究方法：利用西元2002至2003年全民健康保險高屏分局牙科門診申報檔、醫師人數檔及內政部人口檔等，依縣市、鄉鎮區、個人及牙齒為分析單位，探討兒童牙科門診利用的情形，並以MS Access、JMP、Excel等套裝軟體進行統計。結果：(1)西元2002年高高屏澎0-12歲兒童占該區總人口16.6%，其牙科門診醫療耗用759百萬點，占高高屏澎全部牙科門診醫療點數20.3%，醫療費用點數佔率與人口佔率比值，高雄市最高，屏東縣最低，12歲以上人口高雄市比值1.37，屏東縣0.68，0-12歲兒童高雄市比值1.15，屏東縣0.85，隔年兩縣市差距更趨明顯，顯示高雄市使用較多牙醫醫療資源，其他縣市則不足，及12歲以上人口在各縣市城鄉牙醫門診醫療耗用之差異大於0-12歲兒童。 (2)兒童牙醫就診率，縣市差異約10.8%，城鄉差異約20%。兩年來兒童的牙醫就診率由45.1%上升為48.4%；非兒童組牙醫就診率，縣市差異約22%，城鄉差異約28%。 (3)兒童牙科處置醫療費用點數耗用主要為牙體復形74%，其次根管治療16%。其充填以複合樹脂充填56%最高，其次為銀粉充填30%，複合樹脂充填在高雄市都會區用量大於偏遠地區，銀粉充填以澎湖縣偏遠地區用量大於都會區，兩年來複合樹脂充填比率逐漸上升，銀粉充填比率逐漸下降。 (4)兒童乳、恆牙填補以下臼齒填補齒數居多，各為38.4%、46.1%。(5)兒童後牙充填以雙面最多約占60%，經檢定後不同城鄉兒童後牙充填面數無統計上顯著的差異。 (6) 兒童根管治療完成率80%以上，恆牙齲齒充填根管治療率以鄉村居多。(7)地區人口拔除乳牙顆數：城市多於鄉村。結論與建議：兩年來高屏區牙醫門診醫療耗用在縣市與城鄉間不均並無改善；兒童組的就診率高於非兒童組，且非兒童組城鄉間差距更大，顯示兒童組較非兒童組會重視口腔健康，尋求更多牙醫醫療。齲齒治療服務中，發現複合樹脂充填比率逐年增加，而銀粉充填卻顯著減少，與支付點數ヽ環保ヽ美觀及醫師診療行為有關。因此本研究建議在總額預算制度下重視城鄉間牙醫資源的分佈，讓健保資源跟著「人」分佈，而非跟著「牙醫師」分佈。

關鍵字

牙科健保申報；城鄉；醫療需求；牙科醫療利用

並列摘要

Abstract Background：There were great differences between races and urban and rural populations in oral health status and utilization of dental cwere, It is an important stage for body development, good health behavior, and permanent dentition development in 0 to 12 year-old children, but there were few studies which discuss the difference between urban and rural children´s utilization of dental cwere, and dental outpatient consumption. This study was compiled by using the materials from the insurance data of Kaohsiung- Pingtung Branch(Kao- Pin Branch )of the Bureau of National Health Insurance. Objectives:（1）The aim of this study was to compwere utilization of dental outpatient resources between children（under 12 years old）and non-children ( the population over 12 years old) .(2）to evaluate the dental outpatient consumption and difference of children under 12 years old between various cities, counties, and townships in the Kao-Ping Branch of the Bureau National Health Insurance.（3）to assess the discrepancy of urban-rural,and between amalgam compositeresin filling teeth fillings in children Methods: We collected dental claims data of children under 12 years old from dental clinics , dentists data of Kao-Ping Branches of Bureau of National Health Insurance, Population data from the of Ministry of the Interior for 2002 to 2003 were used, according to city, county, and township district, person and tooth unit, to evaluate child utilization of dental outpatient cwere, and statistical analysis was undertaken using MS Access、JMP、Excel statistical packages. Results: （1）Children aged 0-12 were 16.6％ of Kaohsiung City, Kaohsiung County, Pingtung County,Penghu County werea population in 2002,with a dental outpatient consumption of 759 million points(one point always not equal to one dollar), which was 20.3％ of the whole dental outpatient consumption points in this werea. The rate of dental consumption to population was highest in Kaohsiung City, lowest in Pingtung County,1.37 in Kaohsiung City for those aged over 12,0.68 in Pingtung County, and for those aged 0-12 children, 1.15 and 0.58 respectively. The less was more prominent in the following year, which shows more dental resources were used by Kaohsiung City, and deficient in other counties, and the difference of dental outpatient consumption in population over 12 years old was larger than those children aged 0-12 .（2）The difference of dentist visiting rate was 10.8％ between city and county, and 20％ between rural and urban wereas. The dentist visiting rate for children elevated from 45.1％ to 48.4％ in the two years；Difference of dentist visiting rate is 22％ between city and county, and 28％ between rural and urban wereas.（3）The dental management consumption point of pediatric dentistry were restoraten （74％）(mostly), and root canal therapy （16％）was next. The filling used was composite resin （56％） in the majority of case, followed by amalgam（30％）。Composite resin was used in Kaohsiung City more than townships, and more amalgam was used in Penghu County than cities, more composite resins were used than amalgam in the two years of this study.（4）Filling of children´s primary or permanent teeth were lower molars in general,38.4％ and 46.1％ respectively.（5）Posterior teeth filling in children mostly（60％）were dual face, the number of filling faces in posterior teeth showed no statistical significant difference between rural and urban children. （6）Root canal therapy in children was completed over 80％,filling or root canal therapy of permanent teeth caries was performed more in townships.（7）Extraction number of primary teeth in district population：more in cities than in counties. Discussion and suggestions: The imbalance of dental outpatient consumption between cities and counties or rural and urban wereas has had no improvement in these two years；the visiting rate of children was higher than children over 12, and larger difference was found between rural and urban werea children over 12 groups, this showed more concern of oral health in children than children over 12, and seeking dental management. In caries treatment services, more composite resin is used in filling year by year, while amalgam is used less, it is correlated with the payment、environment protection、esthetics、and dentist behavior. It is suggested here that the dental resources between rural and urban wereas must be reevaluated under the global budget system, the budget of the health insurance resources should be focused on the population-based, not the dentist-based.