全民健保制度下1至18歲兒童及青少年牙科門診利用分析

研究背景：隨著全民健康保險制度的實施，兒童獲得牙科醫療資源是非常普遍，但相關研究指出兒童及青少年口腔健康狀況仍顯不佳，與WHO訂定目標仍有差距。以目前實際的健保利用，針對1-18歲兒童及青少年牙科門診醫療利用及牙科門診醫療耗用情形之研究描述略為少見。研究目的：一、分析瞭解1-18歲兒童及青少年，因個人因素（例如年齡、性別、身份別）、投保分局、投保地點、就醫地點，與牙科利用情形和牙科處置費用差異性。二、分析瞭解1-18歲兒童及青少年牙科門診、預防保健利用率及費用情形，以提供予健康保險局、國民健康局及衛生單位作為支付牙科健保項目之參考依據及提昇兒童及青少年口腔照護方針。研究方法：本研究為次級資料的橫斷面研究，資料採用國家衛生研究院提供之2010年全民健保資料庫。分析具全國性代表之承保抽樣歸人檔、重大傷病證明明細檔串檔，擷取1至18歲之兒童及青少年為研究對象，投保人數共有42,031人。並以獨立樣本t檢定、ANOVA、二元邏吉斯迴歸和複迴歸，分析個人因素與牙科利用情形和牙科處置費用之關係。結果：於2010年中健保資料顯示:牙科就診率以女生高於男生(51.43％ vs 45.9％,)；每人每次牙科平均費用女生高於男生(1,117元 vs 1,108元)，一般兒童就診率48.97％＞低收入戶兒童43.77％＞身障兒童35.43＞重大傷病兒童0.46％。牙科門診就診者，其牙科處置利用方面：樹脂充填齲齒顆數41,482顆（每人平均前牙1.72顆、後牙2.06顆）；銀粉充填齲齒顆數1,929顆（每人平均1.64顆）；玻璃離子體充填齲齒顆數1,049顆（每人平均2.15顆）；根管治療齲齒顆數7,549顆（每人平均乳牙1.53顆、恆牙1.14顆、根管清創1.56顆）；拔牙齲齒顆數12,546顆（每人平均乳牙2.01顆、恆牙1.46顆）。0-5歲兒童預防性塗氟率19.8%；身障兒童塗氟率16.83%。以二元邏吉斯迴歸結果顯示，0-6歲及13-18歲年齡層會隨著年齡的增加而提昇牙科利用率；（1）牙科利用方面：女生較高；就醫地點以基層診所較高；13-18歲身心障礙者高於無身心障礙者；低收入戶者較低；投保都市別以直轄市最高；投保分局別以台北分局較高。（2）預防性塗氟方面：為女生、身心障礙者、基層診所、直轄市較高；高屏分局與低收入戶較低，在統計學上皆有達到顯著性差異。以複迴歸結果顯示：影響牙科處置費用費用顯著因素1.洗牙費用：隨年齡增加而提昇利用、女生、身份別（身心障礙）2.樹脂充填費用： 0-6歲、13-18歲、投保都市別（直轄市）、就醫地點（基層診所）、投保分局（北區分局）3.銀粉充填費用：0-6歲、重大傷病4.玻璃離子體充填費用：0-6歲、男生、就醫地點（醫學中心）5.根管治療費用： 13-18歲、身份別（身心障礙）6.拔牙費用： 13-18歲、女生、身障。且在統計學上皆有達到顯著性差異。結論：身心障礙、低收入戶及重大傷病兒童的牙科就醫率較低，因此加強其牙科利用便利性，針對各年齡層的兒童及青少年，除了加強宣導口腔保健之重要性，並經由有效及可近性之管道提供適當牙科服務是十分重要的要務。

關鍵字

全民健保；牙科門診利用；兒童及青少年

並列摘要

Background: Due to the implementation of the National Health Insurance system in Taiwan, it is common for children to receive more dental health care resources. But related research indicates that the oral health status of children and adolescents remains poor and there are still gaps in the goals that the WHO has set. Few studies have reported the utilization and consumption of dental resources for children and adolescents aged 1 to 18 years old. Objectives: 1.. To understand the differences of personal factors (such as age, gender, and identity), insurance district, dental care location and treatment costs of 1-18 year-old children and adolescents. 2. Analysis to understand children and adolescents aged 1-18 dental clinic, preventive health care attendance and costs situation, in order to provide to the Health Council, the National Health Council and the National Health Insurance payment for dental health units as a reference for the project and to enhance child and adolescent oral health care policy. Methods: This is a cross-sectional study of secondary data that used the National Health Insurance Research in 2010 by Registry for beneficiaries (ID) and Registry for catastrophic illness patients (HV) Health Insurance beneficiaries. We selected 1-18 year-old children and adolescents as the study subjects and used independent sample t test, analysis of variance (ANOVA), binary logistic regression and ultiple-regression to analyze personal factors, relationship between the use of dental institutions and dental treatment expenses. Results: The dental attendance rate of girls, (51.43%) was higher than that of boys, (45.9%). The dental average cost in every dental visit of girls was NT$1,117, higher than that of boys NT$1,108. The dental attendance rate of ordinary children was the highest 48.97％,higher than low income families children 43.77％ and then children with disability 35.43, catastrophic illness children was the least 0.46％。 The total treated teeth number for 1-18 year-old children and adolescents in the surveyed year were 41,482 teeth filled with light curing composite resin（1.72 teeth for anterior and 2.06 teeth for posterior in average）, 1,929 teeth with amalgam（in average 1.64 teeth）, 1,049 teeth with glass ionomer cement（in average 2.15 teeth）, 1,897 root canal fillings（1.53, 1.14 and1.56 for deciduous and permanent teeth in average） and 12,546 tooth extractions（2.01 and 1.46 for deciduous and permanent teeth in average）. The preventive fluoride application rate of 0-5 years old regular children and disabled children were 19.8% and 16.83%. By the binary logistic regression,（1） it shows that the dental attendance rate will be increased with increasing age among aged 0 to 6 and 13 to 18, and higher in clinics than in medical center. In age 13-18 adolescent, it is higher in adolescent with disabilities than without disabilities. And it shows higher in non low-income families, in municipality by location insured city and in Taipei Branch by insurance branch. (2) The preventive fluoride application rate shows statistically significantly higher in girls, persons with disabilities, clinics, municipalities, Taipei Branch and non low-income families compare to the counterpart groups. Multiple regression results show that the following factors affect dental treatment costs: 1. Scaling costs: age (7-12 years), gender (female), identity (disabled) 2.Resin filling costs: age (0-6, 13-18), the insured city (municipal city), the insured branch (Taipei Branch), dental care location (clinics), amalgam filling for ages (0-6), identity (catastrophic illness) 3. Glass ionomer cement filling costs: age (0-6), gender (male), medical locations (medical center). 4.Root canal treatment costs: age (13-18). 5. Tooth extraction costs: age (13-18), gender (female), identity (disabled). All the factors show a statistically significant difference. Conclusion: The minorities such as children with disabilities, catastrophic illness and low-income families show lower dental visit attendance rate and lower dental accessibility, in order to improve their dental attendance rate and dental health status, the oral health education and preventive programs should be reinforced. And encourage the dentists to open clinics in low dental resources area to decrease the dental inequality for children are important and urgent.