保險給付病患與非保險給付病患居家照顧利用因素之探討

Comparisons of Home Care Utilizaion between Insured and Not-Insured Patients

劉慧俐(Hui-LI Liu) ； 王鴻昌(Hong-Chung Wang)

《The Kaohsiung Journal of Medical Sciences》 15卷6期 (1999/06) Pp. 382-395

https://doi.org/10.6452/KJMS.199906.0382

摘要

在Andersin-Newman模式中，利用服務的醫療行為主要受到需要因素的影響，其次是在能用因素，再次之為前傾因素，國內許多研究利用此模式檢視之醫療利用結果變得到相同之印證。本研究以此模式來比較保險給付病患與非何險給付病患居家護理利用行為。此外由於居家護理每次之費用並不高，但病患的利用期間長，因此，本研究亦探討影響利用次數之決定因素。研究結果以供計劃擬定及規劃長期照護政策之參考。本研究收集民國83年9月至12月全省居家護理單位之收案個案共637人，訪視回收問卷434份，回收率68.1%。以描述性統計、複迴歸分析等方法分析資料。研究結果顯示，無論保險給付病患或非保險給付病患，其每月的利用次數皆在2次之內，並沒有顯著差異；但研究期間(4個月)之實際利用次數，則保險給付病患每月約2.38次，而非保險給付病患約1.72次，達顯著差異。比較影響保險給付病患與自費病患居家護理利用行為，發現在前傾、能用及需要因素上各有不同。亦即病患年齡較年輕、有慢性病之外的診斷、且家屬較願投入之本省閩南人，雖家庭經資源並不充足，仍會自付費用利用居家護理服務，至於影響長期利用次數之因子，結果顯示：本省閩南籍；住在都市化程度高者，有自已獨棟住宅、有顯著的較多的居家護理利用次數。另接受居家照時間長、每月利用次數多，且日常活動狀況差者亦有顯著較多次數的居家護理服務的次數。全部自變項能解釋62.38%居家護理利用的變異情形。

並列摘要

In the Adersne-Newman model,utilizationof medical services behavior affected by the three favtors of need, neabling, and predisposing. Many studies on medical servives behavior adapting this model obtained the same results. Our study aimed to describe the difference of insrued and non-insured patients using home care, to examine the factors than explain the long-term utilization of home care by using Andersen-Newman model, and to survery the expenditure on home care. Our study collected 486 cases by questionnaires through home interview from various home care untis from Sep.1 to Dec.31 1994. The response rate was 68.1%. Chi-square and multiple regression tests from SAS computer program performed data analysis. Our results showed there waas a significant difference in four months’utilization between insured and non-insured patients (2.38/month vs 1.72/month, p＜0.01). However, if the utilization number per month was less thad two, no significance between the two groups was found. Regarding utilizaton behavior in home care , there were some differeces among the need, enabling, and predisposing factors. Our findings demonstrated young patients, patients with chronic illnessm, and the Fukienese with families involving for care were willing to pay for home care despite the fact that they did not have full support from the family. The determining factors affecting long-term utilization of home care were the Fukienese, patients owning an independent house, hatients with health insurance, and patients who lived in mid- or east-Taiwan. In addition, patients with and elevated number of utilization, patients per month and poor daily activity used home care. All dependent variables could explain 62.38% of variance. The results proposed to the authorities concerned, health institutions and medical professionals for reference in developing home care program.

並列關鍵字

insurance ； home care ； utilization