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全民健保中醫門診利用率及其影響因素

Utilization of Ambulatory Chinese Medical Services under the National Health Insurance in Taiwan

摘要


目標:本研究目的有兩項,第一為描述全民健保保險對象的中醫門診利用率及其在年齡、性別及地區之間的變異;第二為探討個人特質、疾病狀態及地區醫療資源對中醫門診利用率的影響。方法:本研究運用次級資料分析,採用國家衛生研究院提供2000年具有全國代表性之全民健康保險對象個人歸戶資料檔,並透過中央健康保險局數據中心協助,進行門住診明細檔、重大傷病檔及戶籍資料檔等檔案串聯,共完成88,101名2000年在保且存活之我國國民為研究對象。本研究分析中醫門診利用率的影響因素,採用二部模型(two-part model)的迴歸分析。結果:1)2000年健保保險對象每人每年中醫平均利用率為1.264次,女性利用1.477次高於男性利用1.051次,而年齡別利用率呈現“ㄇ”型,35到65歲間呈現高峰,迥異於西醫門診年齡別利用率呈現“J”曲線。2)中醫門診在健保局六個分局轄屬民眾之年齡性別標準化利用率,由高而低分別為中區分局1.922次,南區分局1.302次,高屏分局1.246次,北區分局1.016次,台北分局0.990次,及東區分局0.877次。3)中醫門診在十七個醫療區轄屬民眾之年齡性別標準化利用率差距頗大,最高的前五名分別是台中醫療區2.134次、彰化醫療區1.665次、南投醫療區1.483次、台南醫療區1.347次及雲林醫療區1.309次;最低的後三名分別是台東醫療區0.679次、宜蘭醫療區0.923次、及桃園醫療區的0.954次。最高與最低相差3.14倍。4)二部模型複迴歸分析顯示女性、40歲到70歲、非原住民、居住在中度都市化之市鎮者、慢性病患者、居住於中醫師資源豐富及西醫師資源較少之地區者,其中醫門診利用率顯著較高。結論:研究結果顯示中醫門診利用率的地域性差異甚大,且個人特質、疾病狀態及地區中醫資源均會影響中醫門診利用率。

關鍵字

中醫醫療 門診 醫療利用

並列摘要


Objective: The objectives of this study were: first to describe the utilization of ambulatory Chinese medical services of the NHI enrollees and how it varied according to the insured’s age, sex and geographical location; second to discuss the influences of the characteristics of patients, attributes of the diseases, and local medical resources on the Chinese medical services utilization. Method: This study applied secondary data analysis to representative NHI enrollees sample files in the year 2000 provided by the National Health Research Institute. And with the assistance of the Bureau of National Health Insurance, the sample files were linked with the Family Registration File. A total of 88,101 enrollees alive in 2000 were retrieved as the study subjects. This study used two-part model regression analysis to analyze the factors affecting the utilization of ambulatory Chinese medical services. Result: 1) On average, the utilization rate of ambulatory Chinese medical services was 1.264 visits per person per year in 2000. Female had a higher utilization rate than male (1.477 visits vs. 1.051 visits). However, age-specific utilization rate presented a “reverse U” curve, with a peak occurred among 35 to 65 years of age, in contrast to the ”J” curve of the utilization of ambulatory western medical services. 2) The age-and sex- adjusted utilization rates by the six BNHI branches were (from high to low) : 1.922 visits for the Central Branch, 1.302 visits for the Southern Branch, 1.246 visits for the Kao-Ping Branch, 1.016 visits of the Northern Branch, 0.990 visits for the Taipei Branch, and 0.877 visits for the Eastern Branch. 3) The age- and sex- adjusted utilization rates differed significantly among 17 medical care regions. The five regions with the highest rates were: 2.134 visits for the Taichung medical region, 1.665 visits for the Changhua medical region, 1.483 visits for the Nantou medical region, 1.347 visits for the Tainan medical region, and 1.309 visits for the Yunlin medical region. Three regions with the lowest rates were: 0.679 visits for the Taitung medical region, 0.923 visits for the I-Lan medical region, and 0.954 visits of the Taoyuan medical region. 4)Two-part regression model showed that people retaining the following characteristics were more likely to have higher utilization rates of ambulatory Chinese medical services: female, people aged between 40 to 70, non- aboriginal, sub-urban citizens, patients with chronic disease, and living at areas with more sufficient manpower resources in Chinese medicine but less sufficient manpower in western medicine. Conclusion: The results show that Chinese medical services utilization rates varies significantly among different geographical regions. Besides, patient characteristics, the attributes of diseases and the adequacy of Chinese medical resources, all have an important impact on the Chinese medical utilization rates.

參考文獻


中央健康保險局(2000)。全民健康保險統計。台北:中央健康保險局。
王廷輔(1990)。台中地區居民中西醫療行為取向之研究。17,21-33。
王嘉蕙(1993)。門診利用與買藥行為之相關因素探討。嘉義:國立中正大學社會福利研究所。
吳肖琪(1991)。健康保險與醫療網區域資源對醫療利用之影響。國立台灣大學公共衛生研究所。
吳明玲(1996)。中壢市嬰幼兒使用中醫門診相關因素之研究。15,303-18。

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