原住民健康行為、健康生活品質與醫療資源之使用

研究背景花蓮台東兩縣我們所俗稱的『後山』，是所有人印象中的『人間淨土』，但是因開發落後而經濟不發達，醫療資源更是匱乏。國衛院溫啟邦研究員「台灣健保十年」的評估報告，指出東部人比台北人平均壽命少了將近十歲，健保不但沒有大幅提升民眾的壽命，同時也沒有縮小區域間的健康差異，該研究的結論指出問題在「預防保健」以及「生活型態是否健康」。研究方法本研究採橫斷性研究法，以民國90年由國家衛生研究院與行政院衛生署國民健康局共同辦理「台灣國民健康訪問調查」資料庫中選取花蓮縣台東縣樣本共829筆，並經受訪者同意之中央健康保險局91年醫療費用資料檔共706筆。透過分析，探討原住民族與漢族健康行為、健康相關生活品質與醫療資源使用之差異，同時探討花東民眾醫療資源使用及健康相關生活品質的預測因子。研究結果原住民族與漢族在人口學、社經地位、健康行為、健康狀況、健康相關生活品質上有顯著差異，在醫療總費用、門診使用次數、有無使用住院則沒有顯著差異。以健康相關生活品質八構面各為依變項分析，人口學、社經地位、健康狀況、健康行為、醫療資源使用等變項可為其預測因子。解釋力為身體功能30.29%、身體功能導致角色受限25.24%、身體疼痛程度18.14%、整體健康狀況31.80%、活力狀態20.62%、社會功能19.69% 、心理功能導致角色受限10.13% 、心理健康12.01%。結論期待本研究結果能提供衛生主管機關與醫療機構瞭解原住民族與漢族因族群、文化差異，生活形態、健康確實存在著不同，制定健康議題、健康政策時，應界定山地平地差異，導向健康行為、健康生活方式。以健康相關生活品質預測模式來探討花東民眾健康狀況及行為，解決後山的相對弱勢。

關鍵字

原住民族；漢族；健康相關生活品質(SF-36) ；台灣國民健康訪問調查；偏遠地區

並列摘要

Background Hualien and Taitung commonly known as the most impoverished area are impressed by all of the ‘Land of Virtue’. However, because the economic development is bac- kward and underdeveloped, medical resources are scarce. At the conference ’10-year Experience with Universal Health Insurance in Taiwan’, Chi-Pang Wen, the National Health Research Institution researcher, reported that the average life of people in the eastern area is less than those in Taipei by nearly ten years. Health Care not only failed to substantially improve people’s life but also did not reduce health disparities among regions. The study drew a conclusion to the origins of “preventive health” and “healthy life style.” Method The study selected the 829 samples from the database which was built for “Taiwan National Health Interview Survey” by the NHRI and the Bureau of Health Promotion and 706 pieces of medical expense which were agreed by the respondents. The study aims to investigate the differences in behavior of health, health-related life quality, and the use of medical resources between aboriginals and Han Chinese as well as the forecast of eastern people’s use of medical resources and health-related life quality. Result The result showed that there are significant differences between aboriginals and Han Chinese in the demographic, socioeconomic status, health behaviors, health status, and health-related life quality, while there is no significant difference in total medical cost, the number of out-patient use, and residential use. The study made use of the eight dimensions of the health-related life quality as dependent variables for analysis. The explanation for the physical function is 30.29%, 25.24% for the role limitations of physical problems, 18.14% for the bodily pain, 31.80% for the general health status, 20.62% for the vitality, 19.69% for the social functioning, 10.13% for the role emotional, and 12.01% for the mental health. Conclusion With the result, it is expected that the delivery of health authorities and medical institutions understand the differences in various aspects between aboriginals and Han Chinese. When developing healthy issues and healthy policies, the government should put stress on the mountain-plain differences, health-oriented behaviors, and healthy lifestyles and make use of the forecasting model of health-related life quality to solve the relative vulnerable in Hualien and Taitung.