健保民眾選擇至非健保特約診所自費就醫因素之探討

Study of Insured Patients Choosing to Visit Non-NHI-Contracted Clinics and the Factors Related to this Behavior

蔡文正(Wen-Chen Tsai) ； 邱聖豪(Sheng-Hao Chiu) ； 龔佩珍(Pei-Tseng Kung) ； 陳綾穗(Lin-Sui Chen)

《醫護科技學刊》 4卷1期 (2002/01) Pp. 15-30

https://doi.org/10.6563/TJHS.2002.4(1).2

摘要

目的：全民健保實施至今，仍有民眾放棄至低部分負擔的健保特約診所求診，轉而至非健保特約診所自費就醫。本研究探討民眾選擇至非健保特約診所自費就醫之主要原因。方法：本研究以台中縣市為取樣地區，針對所有健保特約及非健保特約之中、西醫診所，以隨機取樣方式各抽樣10家診所，共40家診所。以結構式問卷進行病患訪談。問卷實際回收848份。並以對數迴歸進行資料統計分析。結果：教育程度、居住地區、民眾對健保的滿意度、罹患慢性疾病、罹患心臟系統疾病、罹患婦科疾病、需復健治療、外傷、骨傷、交通時間長短、醫師的醫術及名氣、自付額的高低等皆為民眾至非健保特約診所自費就醫之顯著影響因素。結論：醫術及名氣是民眾選擇自費就醫之主要原因，其次因為病患熟識醫師而自費就醫。健保相關單位應瞭解為何部分診所醫師不願意、加入健保特約，以及民眾對健保不滿意之處，以供健保制訂政策參考。

關鍵字

自費就醫 ； 非全民健保特約診所 ； 就醫選擇

並列摘要

Objective: This study investigates the reasons why insured patients visit non-National Health Insurance (NHI) contracted clinics instead of NHI-contracted clinics, and examines factors related to this behavior. Method: This study randomly selected 10 pairs of NHI-contracted and non-NHI-contracted clinics in the same area of Taichung city and Taichung Country, including both western medicine clinics and Chinese medicine clinics. A total of 40 clinics were chosen for this study, while the number of effective questionnaires was 848. Multiple logistic regression analysis was applied. Results: From multiple logistic regression analysis‘ he statistically significant factors influencing insured patients to visit non-NHI-contracted physicians at their own expense include education, place of abode, patient's satisfaction with the NHI, chronic diseases, cardiovascular diseases, gynecologic diseases, rehabilitation, trauma, orthopedic diseases, transportation time, reputation and skills of physicians, and out-of-pocket cost. Conclusion: The reputation and skill of physicians is the most important factor attracting insured patients to visit non-NHI-contracted clinics. The second most important reason is close relationship between the patient and the physicians or clinic staff. To improve the NHI program, government must understand the reasons why some of clinic physicians did not contract with NHI program, as well as understand popular dissatisfaction with the NHI program.

並列關鍵字

Out-of-pocket payment ； Non-NHI-contracted clinics ； Patient's medical care choices

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