全民健康保險制度下兒童預防保健服務之利用

Utilization of Well-baby Care Services under National Health Insurance

陳欽賢(Chin-Shyan Chen) ； 朱子斌(Tu-Bin Chu) ； 劉彩卿(Tsai-Ching Liu)

《醫務管理期刊》 7卷1期 (2006/03) Pp. 107-122

摘要

我國自民國84年3月1日全民健康保險制度開辦以來，即針對4歲以下的兒童，免費提供6次的健兒門診，期能評估兒童的發育情形以及身體狀況，儘早發現問題，儘速接受治療，以提升兒童的身心健康水準。本文的目的即是針對台灣地區兒童預防保健服務的利用進行研究。藉由1999-2001年健保申報資料分析結果，發現兒童預防保健服務的使用率其實不高。第一次預防保健服務的利用率最高，約有六成的新生兒接受，但也有兩成的兒童未接受任何的預防保健服務。進一步應用計量經濟模型之多重變項分析，本文發現家庭所得低的兒童，不僅接受兒童預防保健服務的機率低，次數也較少。其次，男嬰的使用率及次數，皆顯著地高於女嬰。再者，低收入戶以及地區人口身份的兒童，接受率顯著地低了許多。此外，區域的差異及兒童本身的特性，尤其是健康狀況對於接受兒童預防保健服務與否也扮演重要的角色。政府有必要加強兒童預防保健服務的宣導及再教育工作，主動解決社經地位較低族群的就醫障礙。花蓮及台東地區兒童預防保健服務率明顯較其他各地偏低，應列為重點加強區域。甚至可以進一步將兒童健檢與預防注射排定相同時程，配套實施，大幅增加兒童預防保健服務的使用率，以促進兒童的健康。

關鍵字

兒童預防保健服務 ； 兒童健康 ； 全民健康保險制度

並列摘要

In Taiwan, all children under four years of age can receive six free well-baby care services after the implementation of National Health Insurance (NHI) in 1995. The purpose of this study is to analyze the utilization of well-baby care services. Using the 1999-2001 National Health Insurance claim data, the results show that the utilization rate of well-baby care services was not as high as expected. The first visit was found to reach the highest rate, around 60%, while 20% of children did not receive any visits. In general, those children with lower family income appeared to have lower utilization of well-baby care than their counterparts. The baby boys seemed to receive more well-baby care than the baby girls. The regional differences and health status also play important roles in affecting well-baby care use. Therefore, the importance of well-baby care and the related educational programs should be further promoted. Furthermore, for the disadvantage children, the health authorities could increase their accessibility of care with full subsidy and strengthen the function of local health stations in providing such services. For the regional inequalities, district authorities have to set up the target rate of services use, particularly in the remote areas, such as Hwalien Hsien and Taitung Hsien. Finally, well-baby care could be combined with the schedule of childhood immunizations to increase the utilization rate in order to improve child health.

並列關鍵字

Well-Baby Care ； Child Health ； National Health Insurance

參考文獻

中央健保局兒童健康手冊。中央健保局。

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