全民健保對牙醫師人力及醫療照護費用之分布探討一以高屏地區為例

The Distribution of Dental Resources under Nation Health Insurance In the Kao-Ping Area

李貞姮(Chen-Heng Lee) ； 藍守仁(Shou-Jen Lan) ； 謝天渝(Tien-Yu Shieh)

《Taiwan Journal of Oral Medicine & Health Sciences》 18卷1期 (2002/10) Pp. 59-69

https://doi.org/10.7059/TJOMHS.200210.0059

摘要

本研究係探討高屏地區全民健保實施後對牙醫師療資源分布情形,主要資料來自中央健康保險局高屏分局「門診申報費用 檔」及「醫事機構管理檔」以民國84年3月至89年12月,牙醫師門診申報之醫療費用資料為研究對象,計4688筆,利用描述性 統計、相關性、迴歸分析及Gini係數作分布評估。研究結果發現:一、高雄縣有6個鄉、屏東縣有13個鄉和澎湖縣的白沙鄉自84年來均無牙醫師人力,健保實施後亦不見改善。 二、每人次費用最高為高雄縣甲仙鄉1204.92元,最低為屏東縣佳 冬鄉為532.54元。每人每年費用最高為高雄市前金區為3006.17元,最低為屏東縣佳冬鄉54.55元。 三、總額支付制度影響,對每十萬人口牙醫師無顯著相關。每人次金額、每人利用次數、每人費用在總額之後比總額前增加。 四、84至89年度與84年度比較、各年度每十萬人口牙醫師、每人 利用次數與每人費用,隨著年度增加,但在每人次費用上在85-87年減少, 89年增加,88年則無顯著相關。
五、以縣市別比較,在每十萬人口牙醫師方面,高雄市最多,依次為澎湖縣、高雄縣、屏東縣。在每人利用次數、每人費用部分 以高雄市最多,依次為澎湖縣、屏東縣、高雄縣。在每人次費用上則澎湖縣最高,依次高雄縣、高雄市。而屏東縣無顯著相關。 六、在人口密度鄉鎮比較,每十萬人口牙醫師數、每人利用次數及每人費用,隨著密度高而增加。但在每人次費用上,人口高密度最高,依次中密度、低密度。在中低密度區則無顯著相關。
七、在高屏地區各鄉鎮84-89年間以Gini係數評估牙醫師人力、醫療資源照護之分布,各項資源之各年度值在0.5-6，故其醫療資 源集中於高密度地區呈現分布不均勻。 依據以上結果建議衛生主管機關,支付制度的改革,除長期監控 醫療費用之變化及支付之合理性外,更應進一步瞭解醫師人力及醫療資源分佈情形,以做為政策制定及支付標準改革之參考。

關鍵字

牙醫醫療資源分布 ； 總額支付制度 ； 吉尼指標

並列摘要

This research was performed to determine the dental resources distribution under National Health Insurance in the Kaohsiung and Pingtung area .The major data are acquired from the Kao-Ping Division, Nation Health Insurance. The time period was from March, 1995 to December, 2000 during which dentists in the area applied for government funds for medical prescriptions issued to their patients. There were 4688 pieces of data analyzed using multiple regression analysis, relativity and the Gini index. The following results were obtained: There are six towns in Kaohsiung County, thirteen in Ping- Tong County, and Pai-Sa Town in Pescadores County. No dentists reside in these areas. No improvement occurred in dental care after National Health Insurance institution. The highest medical charge for an individual patient was 1204.92dollars. The record was set in Chia-Shian Town, Kaohsiung County. The lowest charge goes to Chia-Dong Town, with a cost of 532.54 dollars. The cost for each patient to see a doctor each year was; Cheng-Ching District, Kaohsiung City, with the highest cost of 3006.17 dollars and Chia-Dong Town, with the lowest cost of 54.55 dollars.
The influence of a global budget payment system does not have much relation to the proportion of dentists in the total population. There is tendency toward increase for the cost and frequency of doctor visits after global budget system institution.
The frequency of seeing a dentist increased from 1995 to 2000. However, the cost spent for seeing a dentist decreased from 1996 to 1998. There was an increase in 2000, but no variation in 1999. Fifth, compared with other counties or cities, Kaohsiung City is the area with the highest rate of dentists for everyone hundred thousand residents. Kaoshiung is followed by Pescadores, Kaohsiung County and Ping-Tong County. Kaohsiung City set the highest record for frequency and cost for dental visits, followed by Pescadores, Ping-Tong County and Kaohsiung County.
The higher the population density, the greater the number dentists for every one hundred thousand residents.
Finally, after studying the Gini index for the Kao-Ping area 1995-2000, individual dental resources ranged from 0.5-0.6. Therefore, there is an irregularity in the distribution of dental resources. According to this research result, I suggest that authorities make reforms in the payment system, monitor the long-term variation and cost of medical expenses and balance the distribution of dentists and resources to improve dental care.

並列關鍵字

Distribution of Dental Resources ； the global budget payment system ； Gini index