發展遲緩兒童早期療育醫療資源之利用及其影響因素分析

Analysis of the Utilization and Relative Factors of Early Intervention Medical Service for Developmental Delay Children in Taiwan

儲鳳英(Feng-Ying Chu)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2005年)

摘要

本研究之主要目的在於瞭解發展遲緩兒童早期療育醫療資源之現況，並探討早期療育醫療服務之利用及其影響因素，期能作為衛生、教育、及社政主管機關制定早期療育政策時參考。 本研究為橫斷性研究，以台灣利用早期療育醫療資源之發展遲緩兒童為研究對象，以2002年全民健保資料庫及自行製作之問卷為研究工具。問卷內容設計以Anderson的The Behavioral Model of Health Service Use為理論基礎，問卷共發出2000份，回收之有效問卷為293份，回收率為14.65%。 本研究之主要結果如下： 一、 以91年健保資料庫分析顯示，早期療育兒童之平均年齡為4.44歲，盛行率為3.368%。平均每人全年早期療育之就醫次數為4.16次。男童有32,963人，女童有23,438人，男性在每筆案件金額上較高，但用藥金額、用藥日數以女性較高；有重大傷病卡者為3,388人，沒有者為53,013人，有重大傷病卡者在每筆案件金額、用藥金額及用藥日數上均較無者高。平均每筆申報案件合計金額為1607.05元，用藥日數為3.3日，用藥金額為110.4元，以層級別來區分，申報案件數多集中在醫學中心及區域醫院，合計金額以區域醫院為最高，用藥金額及日數以醫學中心為最高。以權屬別來區分，財團法人醫院之個案為最多，用藥金額及日數也最高。以地區別來區分，台灣北部的個案最多，每筆申報案件合計金額及用藥金額以台灣中部最高，台灣北部與東部比較，東部地區每筆申報案件用藥金額及日數低於北部，但每筆申報案件合計金額高於北部。 二、 問卷分析顯示：發展遲緩兒童平均鑑定月齡為27.45個月，診斷至開始早期療育之日數為56.57日，開始早期療育之月齡平均為30.39個月，平均每周利用早期療育之時數2.19小時，81%同時接受二種以上之治療項目，以職能治療最多，其次是語言治療， 60%接受早期療育相關補助，64.1%領有發展遲緩手冊或證明，29.5%領有重大傷病卡，其主要照顧者84.5%為母親，外籍母親佔7.9%，照顧之困擾因素為缺乏教養資訊較多，對醫院職能及物理治療師滿意度高於鑑定及目前早療之醫師，對醫院就醫流程耗費時間不滿意者較多。 三、 早期療育之醫療資源利用影響因素： 1.發展遲緩兒童之主要照顧者教育程度、年齡、國籍、婚姻狀態及家庭收入等，對兒童之鑑定月齡無明顯差異，兒童具有身心障礙手冊或發展遲緩證明者、有重大傷病者、出生時有缺氧情況或其他缺陷者，在鑑定月齡上會較小。 2.發展遲緩兒童之主要照顧者教育程度較高者、接受早期療育相關補助者、參加社會支持性團體者、做鑑定後曾收到鑑定報告書者、除於醫院進行早療也選擇發展中心早期療育者，其兒童利用早期療育之醫療資源時數上較高。 根據研究結果，本研究提出下述建議：一、衛生主管機關修改全民健保之規定，長期就醫之發展遲緩兒童可比照慢性病患者開立3-6個月早期療育慢性治療醫囑，減輕家庭負擔。另兒童預防保健改採固定時程之健康檢查，避免錯過生長發展遲緩關鍵期。二、政府統整發展遲緩兒童之早期療育補助並加強醫療、社會、教育等機構管理及資源分配公平。三、制定品質監測制度，定期評估早期療育情況並確保品質及充足之早期療育措施。

關鍵字

早期療育 ； 發展遲緩 ； 醫療資源

並列摘要

The purposes of this study are to understand the utilization of early intervention medical services among developmental delay children and what relative factors can influence the utilization for health care, education, and social welfare administration to reference when defining early intervention medical policies. This study is a cross-sectional research. The data resources are questionnaires and the year 2002 database of Nation Health Insurance. A total of 2000 structured questionnaires are issued to gather data from the main caregivers of developmental delay children. Total 293 copies of the effective questionnaires are collected. The response rate is 14.65%. The questionnaire is designed according to Anderson’s The Behavioral Model of Health Service Use. The major findings of this study are: 1. According to the year 2002 National Health Insurance Database, the mean age of the developmental delay children is 4.44 years old. The prevalence rate is 3.368%. There are 4.16 early interventions of medical service visits per person-year. There are 32,963 boys and 23,438 girls. The payment per case for boys is higher than for girls, but the average pharmaceutical days and expense are both lower for boys. The number of children with catastrophic card is 3,388. The catastrophic children have utilized more medical services than without catastrophic card’s children. The average pharmaceutical expense per visit is NT$110.4. Most cases aggregate in medical centers and regional hospitals. The average expense per visit in regional hospitals is higher than the case in medical centers and district hospitals. The average pharmaceutical days and expense in medical centers is the highest. Distinguishing by the ownership, most of cases aggregate in non-profit proprietary hospitals. Their average pharmaceutical days and expenses also are higher than public hospitals’ and private hospitals’. Distinguishing by locale, most of cases aggregate in hospitals of northern Taiwan. The average expense per visit and pharmaceutical expense in the central area are higher than the others. The average pharmaceutical days and expense of eastern Taiwan compared with northern Taiwan are lower, but their average expenses are higher than northern Taiwan’s. 2. The questionnaires reveal the following findings. The mean age of developmental evaluation at the first time is 27.45 months. From confirming the diagnosis of developmental delay to early intervention medical service on average takes 56.57 days. The mean age of getting early intervention medical service is 30.39 months. The children average use early intervention medical service 2.19 hours every week. 81% of them take two types of therapy at the same period. Most of them receive occupational therapy then speech therapy. 60% of them receive early intervention subsidy. 64.1% of them apply the developmental delay certification. 29.5% of them get a catastrophic card from National Health Insurance Bureau. 84.5% of the main caregivers are children’ mother. How to take care and educate children bother them the most . 3. The relative factors of early intervention: There are no significant differences between evaluation age and main caregivers’ education level, age, ethnic group, marital status, or family income. The children who have developmental delay certification, catastrophic card, cyanosis and defects at birth will utilize medical evaluation younger than others. There are several factors that will increase the utilization hours of early intervention medical service, such as higher main caregivers’ education level, receiving early intervention subsidy, joining the support group, having received evaluation report, also if receiving early intervention from the social welfare system. Based on the findings, there are four suggestions: (1) The Department of Health should allow prescribing long term medical orders of early intervention to decrease the family burden (give orders for 3 or 6 months). (2) The government shall set up the subsidy rules and policies to distribute resources equitably. (3) The government should set up a quality monitoring system to ensure the sufficient supply of quantity and good quality of early intervention, and integrate the administration of early interventions among medical, social welfare, education institutions.

並列關鍵字

Early Intervention ； Developmental Delayed ； Medical Service Utilization

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