台灣親密關係暴力被害人醫療利用與費用分析

Medical care utilization by intimate partner violence victims and associated costs in Taiwan

江宛霖(WAN-LIN CHIANG) ； 劉淑瓊(SHU-CHIUNG LIU) ； 黃志中(JOH-JONG HUANG)

《台灣公共衛生雜誌》 39卷1期 (2020/02) Pp. 52-63

https://doi.org/10.6288/TJPH.202002_39(1).108106

摘要

目標：本研究旨在探討台灣親密關係暴力被害人醫療服務利用與費用，並估算台灣親密關係暴力被害人的每人每年醫療費用。方法：本研究使用2015年家暴通報明細檔，以20－64歲14,531位親密關係暴力被害人為研究對象，串聯至全民健保資料庫分析個案的住院、門診與急診醫療利用情形，並比較其與一般就醫民眾（對照組）的醫療利用差異。結果：本研究發現，親密關係暴力被害人在案期間的住院、門診與急診就醫率及就醫次數都比對照組顯著較多。而在醫療費用上，親密關係暴力被害人在案期間的醫療費用亦顯著比對照組高。至於就醫原因，親密關係暴力被害人的住院與門診案件都以精神疾患較對照組來的多，急診案件則是因損傷及中毒而就醫的情形顯著較多。此外，親密關係暴力被害人平均每人每年醫療費用為56,202元，比對照組的23,117元多了33,085元，高約2.4倍。結論：醫療利用成本分析可作為政府發展親密關係暴力預防與醫療服務提供相關政策的有效工具。

關鍵字

親密關係暴力 ； 醫療利用 ； 醫療費用 ； 全民健保資料庫

並列摘要

Objectives: To estimate medical care utilization by intimate partner violence (IPV) victims and the associated costs in Taiwan. Methods: A Ministry of Health and Welfare domestic violence reporting data set containing data of 14,531 IPV victims aged 20-64 years was linked to utilization and cost data from the National Health Insurance (NHI). The NHI data included utilization and costs of medical services, such as impatient, outpatient, and ambulatory care. A comparative analysis of the utilization and costs between IPV victims and non-IPV patients was performed. Results: Compared with non-IPV patients, IPV victims demonstrated higher medical service utilization and associated costs. Moreover, they were considerably more likely to have mental health disorders in inpatient and outpatient settings and have injuries in ambulatory care settings. For IPV victims, the average cost of medical services was NT$56,202 per person per year-approximately 2.4 times higher than that for non-IPV patients. Conclusions: Cost analysis is a tool useful for estimating medical care utilization and associated costs, the results of which can facilitate the formulation of government policies for both IPV prevention and medical service provision.

並列關鍵字

intimate partner violence ； medical care utilization ； medical care costs ； National Health Insurance research databases

參考文獻

黃志中、謝靜雯、周煌智、吳慈恩、陳筱萍、張淳茜：家庭暴力驗傷診斷書品質之介入性研究。亞洲家庭暴力與性侵害期刊 2005；1：27-48。doi:10.29804/AJDVSO.200512.0002。Huang JJ, Hsieh CW, Chou HC, Chen SP, Chan CC. The interventional study of the medical certificates’quality improvement of domestic violence. Asian J Domestic Violence Sexual Offense 2005;1:27-48. doi:10.29804/AJDVSO.200512.0002. [In Chinese: English abstract]

柯麗評：看見你我了嗎：受虐婦女急診室處遇現象之探討。朝陽人文社會學刊 2007；5：241-79。Ku LP. Do you see me and yourself: battered women in emergency room phenomenon exploration. Chaoyang J Humanit Soc Sci 2007;5:241-79. doi:10.30110/CJHSS.200706.0008. [In Chinese: English abstract]

黃志中、陳三能、黃旼儀等：婚姻暴力受虐婦女的身體症狀。台灣家庭醫學雜誌 2004；14：25-34. Huang JJ, Chen SN, Huang MY, et al. Somatic symptoms of battered women in domestic violence. Tw Fam Med Res 2004;14:25-34. doi:10.7023/TJFM.200403.0025. [In Chinese: English abstract]

Fishman PA, Bonomi AE, Anderson ML, Reid RJ, Rivara FP. Changes in health care costs over time following the cessation of intimate partner violence. J Gen Intern Med 2010;25:920-5. doi:10.1007/s11606-010-1359-0

Goldblatt H. Caring for abused women: impact on nurses’ professional and personal life experiences. J Adv Nurs 2009;65:1645-54. doi:10.1111/j.1365-2648.2009.05019.x