老人醫療服務利用之相關因素探討-追蹤1994~2000年高雄市三民區社區老人

目的：探討社區老人之多元功能狀態之變化對其醫療服務利用情形之影響。方法：本研究主要是以居住在高雄市三民區的社區老人為例，依照1994∼2000年追蹤期間老人的死亡與存活情形，將研究樣本區分為存活組(總計621位)與死亡組（總計358位），利用三個時間點老人多元功能評估問卷，配合其醫療服務利用資料，以Andersen的醫療利用行為模式為基礎，分別探討影響存活組與死亡組老人醫療服務利用的相關因素。結果：研究發現存活組老人之社會資源狀態、經濟資源狀態、慢性疾病數、身體健康狀態及日常活動能力等皆優於臨終組老人。而在醫療服務利用方面，臨終組老人則明顯多於存活組老人，前者於臨終前一年之門診及住院費用分別約為50,000元及200,000元，而後者一年之平均門、住診費用則分別為30,000元及50,000元。影響因素方面，存活組老人醫療服務利用情形之影響因子，涵蓋傾向、能力及需要因素，其中需要因素為主要影響因素。一般而言，存活組老人之教育程度越高、工作性質為白領且經濟能力佳者，其對於醫療服務利用會越多;另外，身體健康狀況越佳、日常活動能力越佳的老人，其對於醫療服務利用則較少，上述迴歸分析模式的解釋力約為10%左右。在臨終組方面，需要因素亦為其醫療服務利用情形之主要影響因子，日常活動能力為重度或完全障礙之臨終老人，其死亡前一年之門診及住院費用皆明顯低於活動能力良好者，前者臨終前平均門診費用為14,161元小於後者之平均門診費用24,376元;前者臨終前平均住院費用為114,472元小於後者之平均住院費用244,013元。又，臨終老人之死亡原因對於其死亡前一年住院服務利用亦有顯著影響，死因為腫瘤或內分泌及新陳代謝疾病之老人，其臨終前住院費用明顯較高。結論：本研究比較臨終組老人與存活組老人在同一時期之多元功能狀態發現，臨終組老人在平均年齡方面明顯高於存活組老人，而各功能狀態相較於存活組老人則明顯較差。再者，本研究證實了臨終老人所花費之醫療成本明顯高於存活老人，並瞭解影響兩組老人醫療服務利用之重要因子為需要因素。在建議部分，未來相關政策應更重視老人醫療服務形式之適切性，讓醫療資源得以獲得更妥善的運用。未來相關研究應將醫療服務利用情形擴展至包含其他類型之醫療照護服務，以期更完整地探索老人醫療服務利用之領域。

關鍵字

老人多元功能評估；醫療服務利用；臨終成本

並列摘要

Objective: The major purpose of the study is to evaluate the utilization of medical services of elderly people residing in community by CMFAQ (Chinese-version Multidimensional Functional Assessment Questionnaire). Methods: The data collection was initiated in 1994. The CMFAQ（Chinese-version Multidimensional Functional Assessment Questionnaire）was used to collect functional status and utilization of service. Additionally, NHI data was retrieved to validate the utilization of health care. Samples of 1,260 elderly resided in community were interviewed in 1994. Among them, 874 completed the second interviewed in 1998. The final number of subjects was 643 who were interviewed in 2000. Between 1994 and 2000, there were 621 elderly community residences that received three times face-interviews and 358 deaths. This study separated all the samples from alive group (621) to Deceased group (358). Andersen's (1995) behavioral model was used to assess which factors predictive of health services utilization for community elderly. The relative data was imputed using multi-regression or parametric statistics wherever was suitable. Results: Results show that the social resources, economic resources, the numbers of chronic diseases, physical health status and daily activity living status of alive group are all better than those of deceased group. In addition, the utilizations of medical services of deceased group are higher than those of alive group. The results of multiple regression analyses of impacts of utilization of medical services varied in different health indicators. Generally speaking, the alive elderly with better physical status and activity daily living use less medical services. Besides, the deceased elderly who died in malignance tumors, endocrine diseases and kidney diseases used more medical services. Conclusion: The study improved that deceased elderly used more medical services than alive elderly, and the need factors play an important role on the impacts of utilization of health services for community elderly. Further study should expand the range of medical services in order to explore the utilization of medical services of elderly more completely.