延遲退休對醫療利用之影響

The effect of late retirement on health services utilization

吳春樺(Chun-Hua Wu)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00137

摘要

目的：本研究旨在探討不同退休年齡族群之退休者與相同條件的未退休者醫療利用之差異，與提早退休與延遲退休者和未退休者的醫療利用差異間，是否有所不同以及醫療費用差異是否隨退休時間增加而有所不同。。
方法：採回溯性世代研究之設計，利用全民健康保險資料庫2005年版 100萬抽樣歸人檔(LHID2005)為研究資料。提早退休者以退休年齡介於50-59歲判定，反之在60歲以後退休者則視為延遲退休者。兩組樣本之建構主要先以羅吉斯建構退休預測模型，再由傾向分數配對法(PS, propensity score)進行配對，依照其性別、職業類別、投保單位區域、退休前投保薪資、年齡與退休前的健康狀況，進行一對一貪婪配對(Greedy Match)。醫療利用係指退休組與配對組退休前三年與後六年之西醫門診與住院醫療費用，本研究以配對T檢定及Wilcoxon符號序位檢定分析退休與未退休者醫療利用之差異，再考量性別、退休前職業類別、薪資與健康狀況，以混合模型(mixed model)分析每年醫療利用差異與退休前一年是否顯著不同。
結果：經配對後研究樣本共12,262人，其中50-59歲退休者有9,268人，60-69歲退休者有2,994人。女性、公保、一般鄉鎮、退休前投保薪資、健康狀況及退休前二年整體醫療費用高者其提早退休之機率顯著較高。50-59歲退休者在退休後六年內門診醫療利用顯著高於未退休者，60-69歲退休者之門診醫療利用雖在退休後五年內高於未退休者，惟差異不顯著。50-59歲退休者在退休後五年內整體醫療利用顯著高於未退休者，而60-69歲退休者之整體醫療利用在退休後第四年低於未退休者，惟差異並不顯著。經控制其他影響因素，提早退休者與未退休者之門診與整體醫療利用差異均隨退休時間增加而顯著增加；延遲退休者與未退休者之門診及整體醫療利用差異情形則不顯著。
結論：退休後，提早退休者之醫療利用較未退休者顯著增加，但延遲退休者之醫療利用與未退休者並沒有顯著不同。因此，提早退休對於全民健保財務可能造成負面的影響，反之，延遲退休則並無負面效應，值得納入退休政策之參考。

關鍵字

提早退休 ； 延遲退休 ； 醫療利用 ； 傾向分數法 ； 重複測量

並列摘要

Objective: To compare the different retire-age group of the difference of health care utilization between the retired and continuous workers and to investigate the difference of above difference between early and late retirement.
Methods: With a retrospective cohort study design, we used the National Health Insurance (NHI) registry and claim data containing 100 million of representative enrollee as the source of this study (LHID 2005). The enrollee were classified to early retirement group if they retired between the age of 50 and 59, otherwise they were classified to late retirement group if they retired after the age of 60. A comparative sample was constructed for each group respectively based on propensity score matching which took health conditions before retirement, gender, occupational class, and age into account. Health services utilization covered by the NHI 3 years before and 6 years after retirement between the retirement group and their counterpart are compared year by year, as well as the utilization difference between retirement groups.
Results: Although overall and outpatient health services utilization are different between the retired and continuous workers within 5 years after retirement only in the early retirement group (P <0.01). Controlling for health conditions before retirement, gender, occupational class, and age into account was found overall and outpatient health services utilization difference between the retired and continuous workers increasing with retired years only in the early retirement group (P <0.01).
Conclusion: Health services utilization are significantly higher within retired after retirement compared to those of continuous workers in the early retirement group. Thus, it was worth considered that early retired might had negative impact for national health insurance financial before making retirement police.

並列關鍵字

early retirement ； late retirement ； health services utilization ； propensity score ； repeated measures

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