矯正機關收容人納入二代健保前後之門診使用狀況分析－以花蓮監獄為例

目的：監獄的醫療需求，大多數國家都是由政府編列經費提供，我國以往也採用此公醫模式。自2013年起，收容人改納入二代健保照護體系。本文分析統計花蓮監獄2011至2015年門診資料，以比較健保進入前後之醫療使用狀況。同時說明二代健保在監內實施狀況及遭遇問題，以供眾多承作醫院及相關單位擬定後續政策之參考。方法：分析統計2011至2015年花蓮監獄監內門診資料。包括門診專科狀況，門診人次，每人平均就診次數，常見疾病等。結果：花蓮監獄公醫門診原提供九種專科，二代健保後增加至18個專科。比較2012年和2015年，月平均門診由40.2增加到48.5診次，平均每診人次由39.1下降至27.3，每人每年看診次數也由10.5下降至8.5次。常見疾病包括呼吸道感染、皮膚病、精神疾病。牙科也有高需求，但因治療耗時以致有供應不足情形。結論：矯正機關收容人納入二代健保後，明顯改善了以往公醫門診的眾多醫療缺乏困境。也提供了更週全的各專科，讓收容人各項疾病得到適當治療。配合收費機制及適量管控，監所收容人也較能合理使用醫療資源。

關鍵字

矯正機關；收容人；全民健康保險；二代健保

並列摘要

Background and purpose: Health care costs of inmates at correctional facilities in most countries rely mainly on government funding. In Taiwan, inmates have become eligible for the National Health Insurance (NHI) coverage since 2012. This paper analyzes the outpatient data of inmates at Hualien prison from 2012 to 2015 to compare the status of health care utilization before and after the NHI coverage and to examine the implementation of this policy and the problems it has encountered. Methods: We analysis the statistics data of Hualien Prison clinic from 2012 to 2015, including the number of clinics by specialty, the number of outpatient visits, the average number of visits per person, and common diseases. Results: The number of clinics by specialty increased from 9 to 18 after the implementation of the NHI coverage. During the period from 2012 to 2015, the average number of outpatient visits per month rose from 40.2 to 48.5 times, the average of outpatient visits per clinic per month declined from 39.1 to 27.3 times, and the number of outpatient visits per person per year dropped from 10.51 to 8.54 times. Common diseases included respiratory infections, skin diseases, and psychiatric disorders. Dentistry also reported a considerable demand, but the supply was inadequate due to time-consuming treatment. Conclusion: After the incorporation of inmates at correctional facilities into the NHI coverage, the problem of short supply of medical service has been greatly improved. With the NHI financing mechanism and proper control and management, inmates too can have access to reasonable use of health care resources.