家庭醫師整合性照護計畫對醫療照護利用與結果之影響

The Effect of Family Physician Integrated Care Program on Healthcare Utilization and Outcomes

潘芷昕(Chih-Hsi Pan)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.02186

摘要

研究背景
「家庭醫師整合性照護計畫」行之有年，健保署希望藉此計畫，奠定家庭醫師制度。同時藉此達到減少醫療利用與合理控制醫療費用之目的。不過近年來，很少研究探討此計畫對於醫療照護利用與結果之長期影響。
研究目的
本研究主要探討家庭醫師整合性照護計畫實施對於醫療照護利用與結果之影響。
研究方法
本研究使用全民健康保險研究資料庫2004~2011年之資料，將研究對象分為參與計畫者為實驗組，為避免選樣誤差，以傾向分數配對方法（Propensity Score Matching）配適出控制組。為呈現政策介入之真實差異，使用「差異中之差異（Difference in Difference）」分析方法，再進一步以迴歸模型分析該計畫會對哪些變項造成影響。
研究結果
本研究主要發現於「成人預防保健服務檢查次數（40~64歲組）」達統計上顯著差異，結果顯示家醫計畫會增加研究對象使用預防保健檢查之次數。
結論
本研究結果顯示，於研究期間內，該計畫僅對預防保健服務利用帶來影響，其餘醫療照護利用與結果並無顯著差異。

關鍵字

家庭醫師整合性照護計畫 ； 醫療利用 ； 成人預防保健服務 ； 傾向分數方法 ； 差異中之差異

並列摘要

Background
The Family Physician Integrated Care Program has been implemented for many years. The National Health Insurance Administration wants to establish the foundation plans to reach a Family Physician System by this program. However, in recent years, there have been few studies on the long-term effect of the program on healthcare utilization and outcomes.
Purpose
The purpose of this study was to evaluate the effect of the Family Physician Integrated Care Program on healthcare utilization and outcomes.
Methods
This study used the Nation Health Insurance data from 2004 to 2011. Patients were classified into two groups. Beneficiaries who did not join the program from 2004 to 2006 but joined the program from 2007 to 2011 were classified as an intervention group. Others who did not join the program from 2004 to 2011 were classified as a comparison group. We used the Difference in Difference method, Propensity Score method and multivariate regression models to examine the effect of the program on healthcare utilization and outcomes.
Results
There was an increase in adult preventive services utilization.
Discussion
This study shows that Family Physician Integrated Care Program can increase the prevention services utilization, meaning that family physicians may provide more preventive services to prevent their members from morbidity. However, the effect of the program other healthcare services utilization and outcomes is limited.

並列關鍵字

Family Physician Integrated Care Program ； healthcare utilization ； adult preventive services ； Propensity Score Method ； Difference in Difference

參考文獻

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