資訊不對稱：認知與預防保健服務利用之研究

INFORMATION ASYMMETRY: AWARENESS AND UTILIZATION OF PREVENTIVE HEALTHCARE SERVICES

張譯心(YI-HSIN CHANG)

指導教授 ： 陳欽賢

國立臺北大學/社會科學學院/經濟學系/碩士(2011年)

摘要

民國84年全民健保開辦以來，基於早期發現早期治療的精神陸續推出多項預防保健服務，其中子宮頸抹片檢查、成人預防保健服務歷經十多年的推行，利用率相對初期提升許多，但近幾年維持於固定水準難以提升。本研究使用「2005國民健康訪問暨藥物濫用調查」串連2005至2007年「全民健保資料檔」，子宮頸抹片檢查30-64歲婦女樣本共3769人，成人預防保健40歲以上民眾樣本共6597人，以遞迴雙元普羅比模型探討民眾對於健保免費提供兩項服務的認知及實際利用的影響因素，並分析資訊不對稱下，醫療專業背景的醫護人員資訊認知程度是否高於一般民眾，且更會利用預防保健服務達到健康促進。

研究結果發現，醫護人員對於成人預防保健的認知比率顯著高於一般民眾，而子宮頸抹片檢查的認知比率則沒有顯著差異，可見抹片檢查推廣有其成效；另一方面，醫護人員利用成人預防保健服務的比率顯著地高於一般民眾，顯示醫護人員對於此項服務的肯定，然而，醫護人員與一般民眾利用子宮頸抹片檢查服務的比率則沒有顯著差異。本研究樣本子宮頸抹片、成人預防保健利用率分別為57.89％、41.88％，皆明顯低於認知比率82.01％、76.40％。研究結果也發現，兩項服務認知對於利用沒有顯著地影響。有工作者與無工作者成人預防保健認知比率無顯著差異，但有工作者利用率顯著較低。自覺健康狀態較好者對於兩項服務的認知比率皆高於自覺健康狀態不好者，但利用率卻沒有顯著差異。建議相關單位提供受檢機會成本較高的上班族更多選擇，並多加宣導預防保健可避免罹患嚴重疾病的觀念以提升利用率。

關鍵字

子宮頸抹片檢查、成人預防保健、資訊不對稱、醫護人員、認知

並列摘要

The National Health Insurance program has been providing several preventive healthcare services since its inception in 1995.The utilization rate of both Pap smear test and adult preventive service has increased since then. However, it is hard to increase lately. This study uses recursive bivariate probit model to determine factors affecting awareness and use of the preventive healthcare services. Furthermore, whether health professionals have higher rate of awareness and utilization than the general population is also analyzed under information asymmetry. Data were taken from the 2005 National Health Insurance Survey and the National Health Insurance Database 2005-2007. It included 3769 women who were 30-64 years old and 6597 samples who were 40 years of age or older respectively.

The results showed that physicians and nurses had significantly higher rate of awareness and utilization of adult preventive services than the general population. On the other hand, there was no significant difference on the rates of awareness and utilization about Pap smear test between health professionals and their counterparts. In this study, 57.89％ of the sample received pap smear tests and 41.88％ of the sample received adult preventive services which were much lower than the rate of awareness, 82.01％ and 76.40％, respectively. This study also showed that awareness was not a significant factor affecting utilization of preventive healthcare services. Moreover, the results found that the employed had lower probability of receiving adult preventive service than the unemployed. Individuals with better health status had significantly higher likelihood to be aware of the two services than their counterparts. Government should provide more access to the preventive healthcare services for the workers and educate people the importance of preventive healthcare services.

並列關鍵字

pap smear test, adult preventive service, information asymmetry, physicians, nurses, awareness

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