學齡前兒童健康篩選計畫成本效果評估之研究

學齡前兒童健康管理計畫乃是因應時代需求，對立案之公、私立托兒所、幼稚園兒童免費提供健康篩檢。目的在維護兒童身心健康，期能透過健康篩檢的辦理早期發現異常個案，進而轉介、矯治，並促使其早日恢複健康。本研究乃針對此計畫作整體性評估，以了解學前兒童的健康得檢計畫是否達到其預期目標，其成本效果又如何。分析資料爲衛生署婦幼衛生研究所所編之「托兒所幼稚園健康管理－健康篩選及異常個案追蹤管理報告」，內容包括民國84年至89年篩檢人數、異常人數。經費及人力成本部份，亦由婦幼衛生研究所提供資料（每人次篩檢費用）加以計算。研究發現兒童接受篩檢率與立案率有顯著的正相關；異常個案管理轉介人數，各縣市之間差距不大，歷年比率在4%~5%之間，轉介比率偏低；經轉介之後的就醫百分比，歷年均在九成以上；篩檢正確率，歷年均在五成以上，且有逐年昇高之趨勢；健康篩檢經費，86至88年度健康篩檢經費均在四千二百萬以上，85年因每人次檢查費用較低，健康篩檢經費將近一千八百萬，89年度則因篩檢人數較少，總費用約爲二千六百萬。歷年成本效果比在3400至4600之間，亦即，約花費3400至4600元，能夠確診一位健康異常的兒童（單位：健康篩檢經費／確診異常人次），而影響成本效果比的因素包括需轉介率及確診率。

關鍵字

托兒園所；兒童建康管理；成本效果；轉診率；確診率

並列摘要

The health management program of preschool children was based on the needs of the current generation, it provided free health screening services to the children of both legislated public and private kindergartens and daycare centers. The purpose of a preschool children health management program was the protection of physical and mental health, through the early health screening to detect any abnormal physical conditions and then by prompt referral and treatment to quickly regain health. This study was designed to discover if the health screening plan could reach its anticipated goal and to evaluate it's cost-effectiveness. The data analysis was based on the report of ”Kindergarten/Daycare health management—Health screening and its tracking reports of the abnormal cases provided by The Bureau of Health Promotion, Department of Health, The Executive Yuan, Taiwan. Analysis included the total screening numbers, the abnormal case numbers from 1995 to 2000 and the data of the total cost. The results indicated that the screening rate was positively correlated with the legislation of the kindergartens; the abnormal rate was around 4-5% each year and was no different in different countie, but the referral rate was low; the use of medical resources after referral was high as 90%; the accuracy of screening was around 50% each year as was the trend of increased accuracy; the total cost of health screening was around $4200 million between 1997 to 1999 but only $1800 million in 1995 due to lower costs per case and $ 2600 million in 2000 due to fewer cases screened. The cost-effectiveness ratio was around 3400 to 4600, implying that after spending 3400 to 4600 dollars unhealthy children could be accurately identified; the influencing factors included referral rates and accuracy rates.