台灣兒童之健康平等及醫療照護利用公平性探討

Health Equality and Equity in Health Care Utilization among Children in Taiwan

李昭琴(Sherina Chao-Chin Lee) ； 盧瑞芬(Rachel Jui-Fen Lu)

《台灣公共衛生雜誌》 32卷5期 (2013/10) Pp. 449-461

https://doi.org/10.6288/TJPH2013-32-05-04

摘要

目標：由於兒童為國家未來主人翁，健康水平應格外受到重視，故本研究針對台灣兒童的健康平等及醫療使用之分布公平性和影響因素進行深入探討。方法：資料取自2001年台灣國民健康調查資料，並串連2001年健康保險資料庫，研究對象為12歲以下兒童共3,470名。採用集中指標衡量兒童健康發展情形，並以水平不公平性指標評估所得相關的醫療利用公平性，並進一步分解影響因子。結果：家戶較貧困的兒童較易有學習障礙和發展遲緩的情形。在兒童的醫療使用部分，西醫門診（非預防保健）、牙醫門診和急診的利用均呈現偏富分布，在住院醫療利用則未發現不公平性。同時發現影響兒童醫療利用偏富因素為主要照顧者的教育程度及所得因素。結論：建議政府應投入較多資源以提昇主要照顧者的健康促進觀念，同時在推動兒童醫療補助相關政策時，應考量弱勢家庭的特性，方能有效提供低收入家戶兒童適當的醫療照護。

關鍵字

兒童健康 ； 醫療利用公平性 ； 集中指標 ； 水平不公平性 ； 健康不均度

並列摘要

Objectives: As children represent the future assets of a country, their access to care to maintain their health is critical. This study assessed the distribution of health and health care uses among children. The determinants of the equity distribution were also explored. Methods: The data were taken from the 2001 Taiwan National Health Interview Survey (NHIS) linked with the 2001 National Health Insurance Research Database (NHIRD); 3,470 children aged 12 and younger were identified as the sample. Income-related distribution of health and health care uses were examined by adapting the concentration index and the Index of Horizontal Inequity (HI). Decomposing the concentration index facilitated the identification of factors which contributed to the unequal and inequitable distribution of health and health care uses. Results: Children in poorer households were more likely to encounter developmental problems in hearing and learning. Visits to Western doctors (excluding visits for preventive services), dentists, and emergency rooms tended to show a pro-rich distribution; however, the rich and the poor showed similar patterns of hospital admissions. In general, the educational attainment of the main care giver and household income were the two major factors contributing to the observed inequity. Conclusions: More resources should be devoted to health promotion among care givers. Family characteristics of the socially disadvantaged should be considered when devising subsidy policies targeting children to effectively provide appropriate care to children in need.

並列關鍵字

child health ； equity in health care use ； concentration index ； CI ； Index of Horizontal Inequity ； HI ； health inequality

參考文獻

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