人口老化趨勢下的健康均等與醫療照護公平性之年齡比較

Health Equality and Equity of Healthcare Utilization in Different Age-groups Given the Trend of an Aging Population

陳文意(Wen-Yi Chen) ； 林玉惠(Yu-Hui Lin) ； 梁亞文(Yia-Wun Liang)

《台灣公共衛生雜誌》 31卷1期 (2012/02) Pp. 58-70

https://doi.org/10.6288/TJPH2012-31-01-06

摘要

目標：本研究旨在探討人口老化所達「健康均等性」與「醫療照護公平性」之年齡趨勢假說。其中，「健康均等性」之年齡趨勢假說為：人口老化所達健康分佈均等性之年齡趨勢，應呈現所得相關的健康不均度，將隨著年齡增加而逐漸縮小的趨勢。而「醫療照護公平性」之年齡趨勢假說為：人口老化所達醫療照護公平性之年齡趨勢，應隨著年齡的增加，在考量健康分配差異下，所得相關的醫療利用不公平性，將逐漸縮小，並呈現為「扶貧」分配。方法：我們估計健康生產函數與醫療利用函數，並使用其估計係數計算健康偏集中指數與醫療利用偏集中指數。結果：我國的醫療照護系統，在健康均等性的部份無法達到「健康均等性」的年齡趨勢假說，但醫療利用公平性的部份應能符合「醫療照護公平性」的年齡趨勢假說。結論：全民健保的實施達到人口老化之醫療利用公平性的年齡趨勢後，未來的改革應將國民群體間健康分配不平等的議題列為最重要之考量。（台灣衛誌 2012；31（1）：58－70）

關鍵字

人口老化 ； 偏集中指數 ； 健康不平等 ； 水平不公平

並列摘要

Objectives: The purpose of this study was to investigate two hypotheses about the fairness of healthcare for an aging population. These two hypotheses were (1) the health equality hypothesis, i.e. income-related health inequality should decrease as age increases; (2) the equity of healthcare utilization hypothesis, i.e. given the same health condition, income-related utilization inequity should decrease and tend to be pro-poor as age increases. Methods: We estimated the functions of health production and healthcare utilization, so that these estimates could be used to calculate the partial concentration indices of health and healthcare utilization. Results: Our results indicated that Taiwan's healthcare system failed to meet the standards proposed by the health equality hypothesis, but satisfied the requirements of the equity of healthcare utilization hypothesis for the aging population. Conclusions: Taiwan's healthcare system has reduced the income-related inequity of healthcare utilization due to implementation of National Health Insurance. Healthcare reform should now focus on decreasing health inequality. (Taiwan J Public Health. 2012; 31(1):58-70)

並列關鍵字

aging population ； partial concentration index ； health inequality ； horizontal inequity

參考文獻

內政部統計處：重要參考指標―重要內政統計指標，2010。http://www.moi.gov.tw/stat/。引用2011/09/20。Department of Statistics, Ministry of the Interior, R.O.C. (Taiwan). Statistical index for internal affairs, 2010. Available at: http://www.moi.gov.tw/stat/.Accessed September 20, 2011

內政部統計處：內政國際指標―主要國家老化指數，2009。http://www.moi.gov.tw/stat/。引用2009/10/20。Department of Statistics, Ministry of the Interior, R.O.C. (Taiwan). Interior national indicators: aging index by selected countries. Available at: http://www.moi.gov.tw/stat/. Accessed October 20, 2009.

()。

WHO(2000).The World Health Report 2000 - Health Systems: Improving Performance.,::WHO.

Department of Health and Social Security(1980).Inequalities in Health: Report of a Research Working Group.Black Report.(Black Report).,::DHSS.