探討民眾對健保IC卡使用的情形與看法

研究旨在探討民眾對於健保IC卡之滿意度與使用情形。以結構式問卷為測量工具，採立意取樣法，以大台北地區各層級之醫療機構（醫學中心、區域醫院、地區教學醫院及基層醫療院所）分別隨機抽取三家作為問卷發放地點，共計12家醫療院所。並以領藥民眾為問卷發放對象，採每10號為一抽樣間隔，同時為避免抽樣誤差，問卷發放地點將依上午看診時段及下午看診時段分別各抽取10位，每日20位，連抽5日，每家醫療院所100位，總計1,200位，扣除資料不齊等原因之無效問卷，共計有效問卷1,133份，回收率達94.4%。首先以t檢定或卡方檢定進行雙變項分析，探討受訪者基本特質及受訪者對醫療隱私的態度與民眾對健保局處理健保IC卡醫療隱私滿意度之相關性。然後再進行邏輯斯迴歸(Logistic Regression)分析影響民眾對健保局處理健保IC卡醫療隱私滿意度之相關因素。研究結果發現：有高達59.1%受訪者“滿意”或“很滿意”健保IC卡的使用，“不滿意”或“很不滿意”僅占3.0%；對於健保局、醫療院所和醫護人員處理IC卡醫療隱私之滿意度，認為普通的比率分別高達56.7%、62.4%及64.0%。在邏輯斯迴歸分析中，經調整其他變項之影響效應後，發現教育程度為高中（職）（以大專為參考組，勝算比=1.51，95%信賴區間為1.81～2.10）、平約月收入為無收入（以20,001至39,999元為參考組，勝算比=1.95，95%信賴區間為1.25～3.04）或20,000元以下以（20,001至39,999元為參考組，勝算比=2.05，95%信賴區間為1.32～3.19)，及贊同健保IC卡中的個人辨識密碼可以保護卡片資料的安全（勝算比=1.49，95%信賴區間為1.23～1.82）者，其對健保局處理健保IC卡醫療隱私滿意度之勝算(Odds)較高。而較認同健IC 卡中的紀錄在資料讀取或傳輸時有外洩的可能（勝算比=0.69，95%信賴區間為0.55～0.86）者，其對健保局處理健保IC卡醫療隱私滿意度則較低。根據本研究結果，建議衛生主管機關(1)發行「健保IC卡使用須知」；(2)宜制訂台灣版之「健康保險可攜性與責任性法案」(Taiwan Edition Health Insurance Portability and Accountability Act)」。

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並列摘要

This study was aimed to explore consumers' satisfactions and experiences of using the national health insurance (NHI) IC card. A structured questionnaire was used to collect data. A total of 1,200 sampled subjects were selected by purposeful sampling from 12 hospitals in Taipei which include all levels of medical organizations. In total there were 1,133 valid questionnaires returned, and the response rate was 94.4%. T-test and chi-squared tests were conducted to explore the subjects' characteristics and the significance between consumers' attitude toward medical privacy and the satisfaction with the bureau of National Health Insurance's (BNHI) dealing with the medical privacy of NHI IC card. A logistic regression analysis was performed to understand those factors which were related to consumers' satisfactions of BNHI dealing with the medical privacy of NHI IC card. Among the sampled subjects, 59.1% consumers were ”very satisfied” or ”satisfied” with the NHI IC card; 56.7% of consumers' satisfaction of BNHI dealing with medical privacy of NHI IC card were rated ”common”. The logistic regression analysis found that people who endorse the Personal Identify Number to protect the security of NHI IC card (OR=1.49, 95% CI=1.23～1.82) were those who had the highest degree of senior high school (OR=1.51, 95% CI=1.81-2.10), and those who have no monthly incomes (OR1.95, 95% CI=1.25～3.04) or less than 20,000 (OR=2.05, 95% CI=1.32～3.19). And they were more satisfied with BNHI dealing with medical privacy of NHI IC card. However, those who indicate that their personal information were stolen possibly while the records were being loaded or transmitted (OR=0.69, 95% CI=0.55～0.86) were less satisfied with the NHI dealing with medical privacy of NHI IC card. It is recommended that a publication of ”operation instructions of NHI IC card” be distributed and the government should formulate the Taiwan Edition HIPAA (Taiwan Edition Health Insurance Portability and Accountability Act).