健康、醫療利用與人口移動的關聯

Relationship between Health, Medical Utilization and Domestic Movement

余清祥(Jack C. Yue) ； 梁穎誼(Yin-Yee Leong) ； 林佩柔(Pei-Rou Lin)

《地理學報》 102期 (2022/08) Pp. 55-80

https://doi.org/10.6161/jgs.202208_(102).0004

摘要

人們因為資源需求、氣候變遷等因素而改變居住地區，21世紀更因為全球化發展使得遷移成為重要人口特質，然而人口移動不易追蹤，尤其國內遷移的資料更不易蒐集。我國為少數實施戶籍登記的國家，內政部的戶籍遷徙資料可用於評估國內遷移，但戶籍搬遷未必與實際的常住人口移動一致。我國全民健康保險（簡稱健保）的納保率已達99.6%，醫療院所特約率也有93%，健保已是國民日常生活的一部份，因此本文以健保資料庫的就醫紀錄探討國人國內移動，評估移動與醫療利用、死亡率的關聯，希冀研究結果可做為國人遷移的參考。本文根據健保資料庫的2005年承保抽樣歸人檔，透過門診處方及治療明細檔等紀錄，將合計點數小於555點的就醫地視為常住地，以此判斷國內人口移動，探討移動者的醫療利用及死亡率等特性。研究結果發現：健保移動遠較戶籍遷移頻繁，青壯年的移動比例較高，移動的方向以六都和鄰近的縣市為主；移動與醫療利用、死亡率有關，移動者的死亡率高於不移動者，但門診次數卻以不移動者較多。其中，縣市間移動者的門診次數最少，但每次門診平均點數較高，意謂縣市間的移動可能與醫療需求有關；國內人口移動也與性別有關，死亡率以男性縣市間的移動者較高。

關鍵字

人口移動 ； 全民健康保險資料庫 ； 空間分析 ； 醫療利用 ； 死亡率

並列摘要

Reasons for migration include resource needs and climate change. Globalization has made migration an important demographic characteristic in the 21st century. However, tracing population movement is difficult and the official household registration from Ministry of the Interior cannot reveal the actual movement of permanent residents. Conversely, more than 99% of Taiwan's residents participate in Taiwan's National Health Insurance (NHI) program, which was implemented in 1995. Previous investigations have found that people tend to have outpatient visits in their living areas for minor illnesses. Therefore, this study applies the medical records from these outpatient visits to study Taiwan's domestic migration of permanent residents. This study explores the relationship between medical usage and domestic migration, based on sample data set LHID2005 from the National Health Insurance Research Database (NHIRD). We found that the NHIRD shows higher migration rates than Taiwan's household registration. Young adults move more frequently than other groups, and most migrants move to nearby municipality and cities. Migrants have higher mortality rates than non-migrants. Those who migrate to cities have less medical utilization but higher medical costs (i.e., more serious conditions), indicating that the migrants are less healthy or require more medical resources. Additionally, the impact of domestic movement is different for men and women, and male migrants have higher mortality rates than female migrants.

並列關鍵字

Population movement ； National Health Insurance Research Database ； spatial analysis ； medical utilization ； mortality rates

參考文獻

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