Factors Associated with Access to Healthcare for Infertility Problems under Taiwan's National Health Insurance Program

不孕症婦女尋求全民健保醫療照護之相關因素探討

陳麗光(Likwang Chen) ； 施淑芳(Shu-Fang Shih) ； 林陳立(Chen-Li Lin) ； 楊惟智(Wei-Chih Yang) ； 郭耿南(Ken-Nan Kuo)

《健康促進與衛生教育學報》 43期 (2015/06) Pp. 59-76

https://doi.org/10.3966/207010632015060043003

摘要

In Taiwan, there is little study on how many women seek consultation or treatment from the National Health Insurance system and the characteristics of these women so far. Our study aims to estimate the number of women who seek consultation or treatment for infertility, analyzed their comorbidities and investigated the factors that are associated with infertility care seeking in Taiwan. We used the 2005 Longitudinal Health Insurance Database. Those women who aged between 20 to 49 years old on January 1, 2015 were included in our analysis and the total sample size was 191,917. We identified the infertility cases using the ICD9-CM 628 diagnosed by OB/GYN physicians from outpatient care (CD) and inpatient (DD) claims data. We estimated the number of women who have sought for help due to infertility problems, analyzed their related comorbidities, and used the logistic regression model to investigate the factors associated with the access to healthcare for infertility problems. The results showed that more than 133,000 Taiwanese women sought consultation and/or treatment for infertility from 2005 to 2009. The top three diseases associated with infertility included disorders of menstruation and other abnormal bleeding from the female genital tract, ovarian dysfunction, and the inflammatory disease of cervix, vagina and vulva. Those who had a higher socioeconomic status were more likely to seek consultation and/or treatments for infertility. There is a pressing need from women who desire to have children in Taiwan in spite of the decreasing fertility rate. Health promotion programs or patient education for women should focus more on reproductive health and prevention of diseases related to infertility or emphasize the importance of healthy behaviours for reproductive health. More research on investigating whether infertile couples have childbirth is suggested.

關鍵字

access to health care ； infertility ； National Health Insurance Program ； women

並列摘要

國內目前對於有多少婦女曾經因不孕症困擾而至全民健保體制內尋求諮詢或治療，以及對於該族群之相關特性並不是非常了解，因此，本研究目標為了解國內因不孕症困擾而求醫之婦女人數以及其社會人口學特性與相關疾病。本研究運用2005年全民健保承保抽樣歸人檔進行分析，篩選2005年1月1日年齡為20～49歲191,917位女性之資料，確認這些婦女是否在2005至2009年間就醫科別為婦產科，且門診處方、治療明細檔及住院醫療費用清單明細檔中其任一國際疾病分類號為628之就醫資料，再進行歸人分析。本研究估算曾因不孕症困擾求醫之婦女人數，並運用羅吉斯迴歸分析法分析與婦女尋求不孕症醫療之相關因素。本研究結果顯示，臺灣從2005至2009年間，有133,000位婦女曾被下不孕症之診斷。與婦女不孕症診斷相關的前三項就診次數最高的婦女疾病為月經異常病患及其他生殖道之異常出血、卵巢功能障礙、子宮頸、陰道及女陰之炎症。較高社經地位之婦女比低社經地位之婦女更可能尋求不孕症之治療。雖然臺灣生育率很低，但仍有許多婦女曾因不孕症之困擾尋求醫療協助。與不孕症相關之疾病以月經、卵巢、子宮頸及陰道相關疾病居多，建議未來推動病人衛生教育或健康促進計畫時，可強化婦女對於不孕症相關疾病之了解，或強調健康行為影響生育健康之觀念。未來可更深入了解不孕症婦女後續生育之狀況。

並列關鍵字

求醫 ； 不孕症 ； 全民健保制度 ； 婦女

參考文獻

Chachamovich, J. R., Chachamovich, E., Ezer, H., Fleck, M. P., Knauth, D., & Passos, E. P. (2010). Investigating quality of life and health-related quality of life in infertility: A systematic review. Journal of Psychosomatic Obstetrics and Gynecology, 31(2), 101-110.

Dill, S. (2002). Consumer perspectives. In E. Vayena, P. J. Rowe, & P. D. Griffin (Eds.), Current practices and controversies in assisted reproduction: Report of a meeting on “medical, ethical and social aspects of assisted reproduction” (pp. 255-271). Geneva, Switzerland: World Health Organization.

Domar, A. D., Zuttermeister, P. C., & Friedman, R. (1993). The psychological impact of infertility: A comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynaecology, 14 Suppl, 45-52.

Downey, J., Yingling, S., McKinney, M., Husami, N., Jewelewicz, R., & Maidman, J. (1989). Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation. Fertility and Sterility, 52(3), 425-432.

Fathalla, M. F. (2002). Current challenges in assisted reproduction. In E. Vayena, P. J. Rowe, & P. D. Griffin (Eds.), Current practices and controversies in assisted reproduction: Report of a meeting on “medical, ethical and social aspects of assisted reproduction” (pp. 3-12). Geneva, Switzerland: World Health Organization.