老年榮民與非榮民醫療服務利用之比較分析

為瞭解老年榮民與非榮民在醫療服務利用之差異情形及影響因素。本研究以內政部2009年老人生活狀況調查資料庫內65歲以上老年人口作為研究對象，整體研究樣本3153人，其中老年榮民288人、非榮民2865人。研究主要發現：（1）老年榮民健康情形普遍較非榮民為差。（2）老年榮民與非榮民在門診與住院服務利用上並無不同。（3）高齡、低教育的榮民，則慢性及重症病數較多，且ADL失能與IADL障礙程度也較高；高齡、單身、低教育的非榮民，則是慢性及重症病數較多，且ADL失能與IADL障礙程度也較高；教育程度變項對老年榮民健康狀況有較高的預測力，而年齡變項則對非榮民健康狀況有較高的預測力。（4）經濟狀況愈好、自評健康愈差、慢性及重症病數愈多的老年榮民，則門診服務利用率愈高；而教育程度愈高、自評健康愈差、慢性及重症病數愈多、憂鬱程度愈高的非榮民，則門診服務利用率愈高；兩者皆以「慢性及重症病數」預測力最高。（5）自評健康愈差、慢性及重症病數愈多、ADL失能程度愈高、IADL障礙程度愈高的老年榮民，則住院服務利用率愈高；而男性、單身、自評健康愈差、疾病數愈多、憂鬱程度愈高、ADL失能程度愈高、IADL障礙程度愈高的非榮民，則是住院服務利用率愈高；影響兩者住院服務利用的重要因素為「個人健康狀況」。研究建議：（1）退輔會應持續辦理醫療需求與三級醫療整合供需關係研究。（2）退輔會應將榮民就醫資訊透明化與公開化，化解猜疑。（3）制訂並宣導推動「健康促進」與「預防保健」政策。（4）規劃推動高齡人口慢性病照護計畫。（5）研議失能者在地老化的連續性照護政策如何接軌長照保險。（6）善用健康高齡人力資本。

關鍵字

老年榮民；健康狀況；醫療服務利用

並列摘要

This study is to understand the influences of personal backgrounds, social strata, and health statuses on the medical utilization of aged veterans and non-veterans. The subjects were sampled from the elderly population aged over 65 who were included in the Ministry of the Interior's year 2009 survey database of the elderly. The sample size is 3153 including 288 aged veterans and 2865 non-veterans. The data were analyzed statistically with descriptive statistics, chi-square, multiple regression and logistic regression. The results of this study showed that: (1) aged veterans' health statuses were generally worse than non-veterans; (2) there were no differences in the utilization of outpatient and inpatient services between aged veterans and non-veterans; (3) those veterans who were elderly and poorly educated had more chronic and severe diseases and had a higher degree of disability in ADLs and difficulty in IADLs; those nonveterans who were elderly, single, and poorly educated had more chronic and severe diseases and had a higher degree of disability in ADLs and difficulty in IADLs; the variable, ”education”, has a higher predictive power for aged veterans' health statuses while the variable ”age” has a higher predictive power for non-veterans' health statuses; (4) those aged veterans who had better economic statuses, worse self-assessed health statuses, and more chronic and severe diseases had a higher rate of utilizing outpatient services; those non-veterans who were better educated and had worse self-assessed health statuses, more chronic and severe diseases and a higher degree of depression had a higher rate of utilizing outpatient services; In both cases, the variable ”the number of cases of chronic and severe diseases” has the strongest predictive power; (5) those aged veterans who had worse self-assessed health statuses, more chronic and severe diseases, and a higher degree of disability in ADLs and difficulty in IADLs had a higher rate of utilizing inpatient services; those nonveterans who were male and single, and had worse self-assessed health statuses, more diseases, a higher degree of depression and a higher degree of disability in ADLs and difficulty in IADLs had a higher rate of utilizing inpatient services; In both cases, the personal health status is an important factor that has an influence on the utilization of inpatient services. The suggestions from this study are: (1) the Veterans Affairs Commission should continue to conduct studies related to the supply-demand relations between medical-care needs and three levels of medical care; (2) the Veterans Affairs Commission should make medical care information known to veterans to resolve mistrust; (3) formulate and promote policies concerning ”health promotion” and ”prevention and healthcare”; (4) plan and promote the healthcare program for elderly patients with chronic diseases; (5) investigate how the policy concerning the aging-in-place continuous care for disable persons can be integrated with long-term care insurance; (6) make the best use of the manpower capital of healthy elderly persons.

並列關鍵字

Aged veterans ； Health status ； Medical utilization

國際替代計量

老年榮民與非榮民醫療服務利用之比較分析

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