臺灣高齡人口移動與健康探討

因為壽命延長、生育意願降低，近年亞洲各國人口老化速度加快，以臺灣為例， 2020年年底65歲以上（簡稱高齡人口）佔整體人口超過16%，預計於2025年超過20%，進入超高齡社會（來源：國家發展委員會）。高齡人口的醫療需求較多，人口老化也意謂健保費用的上升，2018年高齡人口醫療費用佔整體健保38.2%，每位老年人醫療花費約為全國平均五倍以上（來源：中央健康保險署）。由於高齡人口的活動能力不如年輕人，各地區醫療利用的差異也顯示健保的潛在問題，例如：就醫便利性、資源分配、陪伴照護等，根據衛福部2017年的台灣健康不平等報告書，也發現經濟（及都市）發展與死亡率高低、不同死因等存在關聯性。不患寡而患不均，正是我國健保亟需解決的問題之一。本文以高齡人口遷移、健康與地區的關聯為研究目標，希冀研究結果可供政府及國人參考，為消弭地區不平等而努力。本文依據全民健保資料庫2005年百萬高齡人口抽樣檔及2005年百萬人抽樣檔，藉以定義人口遷移以及測量死亡率、醫療利用。其中百萬高齡抽樣檔為隨機抽取2005年年底仍存活的百萬高齡人口，紀錄2002至2013年的就醫行為，因為高齡人口抽樣比例達45.7%，高涵蓋率有助掌握老年人醫療利用。本文依據資料庫的門診處方及治療明細檔（CD），將每次門診點數小於555點就醫地視為經常活動地，除了探討高齡人口的遷移行為，並比較不同遷移類型的死亡與就醫特性。分析發現高齡人口移動比例逐年下降，如果將移動分成縣市間、縣市內（不同鄉鎮市區）及未移動，則縣市間移動者的死亡率最高、未移動者最低；醫療利用則以縣市間移動者的門診點數最高，未移動者最低，而從非六都移出的高齡女性的健康明顯不如從六都移出者。此外，當高齡男性遷移時間和死亡相距越近，其門診次數較少、但每次門診就醫點數較高。

關鍵字

高齡人口；人口移動；全民健康保險；醫療利用；死亡率

並列摘要

Prolonging life expectancy and low fertility rates accelerate population ageing in Asian countries. For example, the elderly (ages 65 and beyond) accounted for 7% Taiwan’s population in 1993 and are expected to reach 20% in 2025, according to National Development Council. Older people usually require more medical attention and they used 38.2% of total National Health Insurance (NHI) budget in 2018, although the elderly population was only 14.1%. Despite the fact that the NHI guarantees access to medical care, medical resources vary for different places. This creates incentive for internal migration. The goal of this study is to explore the health of elderly migrants and, in particular, we want to know if there is health inequality behind internal migration. In this study, we used the data from NHI Research Database to define the internal migration and to measure the health of elderly migrants. We divide the elderly into three types: non-migrants, within-county migrants and between-county migrants. We found that the elderly’s migration activity gradually decreased, similar to the official records from Ministry of the Interior. As for migrants’ health, between-county migrants have the highest mortality rates, while non-migrants have the lowest morality rates. The expenses of outpatient visits were higher than those of other migration types. Also, we found that elderly men had fewer outpatient visits but higher outpatient expenses, as the migration approaching the time of death.