門診高診次醫療利用之相關因素探討

Investigation of the factors related to high medical utilization among outpatients care in Taiwan.

陳蓓綺(Pei-Chi Chen)

指導教授 ： 張永源

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2005年)

摘要

目的：醫療費用的持續上漲是各國共有的現象，但我國的門診醫療利用之高，卻是世界各國少有之情形。有鑑於我國異常的門診醫療利用情形，本研究目的在探討門診高診次醫療耗用者之人口學特徵和醫療院所屬性，及其對門診醫療資源耗用情形。
方法：本研究以2001、2002年全民健保學術研究資料庫之抽樣歸人檔為資料來源，以全年西醫門診次數最高的5％病患為高門診利用者，2001、2002年分別有2086人和2044人，進行分析。
結果：
1.西醫門診次數最高的5％病患，2001、2002年每人每年平均利用門診51.37次和52.27次，各佔其全年總門診人次的21％。
2.高利用者在每人每年門診費用、平均每次門診費用、各細項門診費用和拿藥天數上皆顯著多於一般利用組。顯示高利用者比一般利用者在門診就醫時使用更多醫療資源。
3.高利用者和一般利用者之前20名就醫疾病中皆以急性呼吸道疾病較多，但是高利用者在眩暈、頭痛和下背痛的就醫診次比例高於一般利用者。
4.經迴歸分析，年齡越大為高門診利用者之機率越高。第三類保險對象較第一類和投保金額為15840元以下者較其他投保金額別為高門診利用者機率均較高。有慢性病者、重大傷病者和曾經於當年住院者有較高的機率為高門診利用者。而固定至醫學中心就醫者較至其他層級就醫者有較少高門診利用者；固定至中區、南區和高屏分局就醫者較固定至台北分局就醫者有較高的機率為高門診利用者。當同樣為高門診利用者時，在人口學特性上，以男性、年齡較大和曾經住院者利用較多的門診次數，而年齡較大和重大傷病者則耗用較多的門診費用。而在就醫屬特上，固定至基層診所就醫者較固定至醫學中心就醫者利用較高的門診次數，但固定至醫學中心就醫者花費較多的門診費用。固定至高屏分局就醫者較固定至台北分局就醫者利用較高的門診次數。
結論與建議：本研究發現個人特質和就醫屬性的不同確實會影響門診醫療利用高低，因此相關機關應針對這群高利用者加強衛生教育，並對病情穩定之慢性病者開立連續處方籤，以減少不必要的門診醫療浪費。

關鍵字

門診次數 ； 高醫療耗用者 ； 次級資料分析 ； 全民健康保險

並列摘要

Objective The medical cost rising continually is common in most countries, but the high utilization of ambulatory care is rare. The study aims at examining the relationship of demography of ambulatory for high users, characteristics of visiting places and anomalistic utilization of ambulatory care in Taiwan.

Methods Data is 2001 and 2002 Panel Claims Data from NHI Research Database (NHIRD). The highest 5% of utilization of ambulatory care per year are high users of ambulatory care, with a size of 2086 samples in 2001 and a size of 2044 samples in 2002.

Results
1.The average utilization of high users per year is 51.37 times in 2001 and 52.27 times in 2002, of them, 21% total utilization of ambulatory care per year.
2.The expenditures of ambulatory care per year, average expenditures of ambulatory care per visit, other medical expenditures and days of prescription among high users are more than general users.
3.There are more acute respiratory infections among high users and the first 20 people of general users. The giddiness, the headache and the low back pain have higher ratio of ambulatory care among high users.
4.By using multiple regression analysis, we found that, the older is more high users than the younger; the type three insured are more high users than the type one insured. The enrollment payroll category under 15840 is more high users than other ones. The chronic disease, the major illness and the experience of hospitalization are more high users than other patients. The users of attending to medical center are less users than that of attending to other level. The users of attending to central, southern and Kao-ping area are more high users than that of attending to Taipei area. Among high user, the male, the older and the experience of hospitalization use higher visits of ambulatory care; the older and the major illness use more expenditures of ambulatory care; the users of attending to primary care use higher visits of ambulatory care than that of attending to medical center, but the users of attending to medical center have more expenditures of ambulatory care; the users of attending to Kao-ping area use more visits of ambulatory care than that of attending to Taipei area.

Conclusion and suggestions Our study found that different personal attitude and characteristics of visiting places actually affect the uses of ambulatory care. Therefore, related agencies should enforce education of health and give chronic patient prescription refills to reduce unnecessary uses of ambulatory care.

並列關鍵字

Ambulatory care for high users ； Medical visit ； Secondary data analysis ； National Health Insurance

參考文獻

國內相關參考文獻

1.行政院衛生署統計資料，網站：http://www.doh.gov.tw。

2.中央健康保險局網站，網址：http://www.nhi.gov.tw。

3.王秀蕙，全民健保實施西醫基層總額支付制度成效評估-以高屏分局為例，高雄醫學大學公共衛生學研究所碩士論文，2002。

4.江君毅，大醫院或小診所？影響民眾選擇就醫層級因素之研究，國立台北大學經濟學系碩士論文，2002。