民國85年健保局開辦成人預防保健服務,期望以早期發現早期治療增進民眾健康。自開辦以來使用率卻維持在四成左右,且對於後續醫療利用並無深入的探討。因此本研究使用「2001國民健康訪問調查」串聯民國90年以及民國91年「全民健保資料檔」共2,156位六十五歲以上老年人,探討其民國90年預防保健服務利用情形以及民國91年醫療利用情形。本研究以邏輯斯迴歸分析預防保健服務使用率,並以二部模型分析後續醫療利用情形。門診機率以及住院機率以邏輯斯迴歸分析,門診次數以及住院天數以負二項分配迴歸分析,門診費用以及住院費用以普通最小平方線性迴歸分析;並且使用工具變數進行二階段迴歸以解決醫療利用所存在之內生性問題。研究結果發現,使用率為31.03%的確偏低,而影響預防保健服務使用的因素中,年齡75-84歲老年人使用率顯著低於65-74老年人,中部地區以及南部地區老年人使用率顯著高於北部地區老年人,自覺狀態良好者使用率顯著低於自覺狀態不好者,此外有活動限制者、無運動者以及吸煙者使用率顯著較低。使用預防保健服務者,門 診機率顯著高於未使用者,顯示發現疾病機率較高。住院天數顯著低於未使用者,顯示透過早期的檢查,可以降低罹患嚴重疾病的可能性,因此判斷預防保健服務,有早期發現早期治療,增進健康之效果。
Since the inception of the National Health Insurance System in 1996, the bureau has been providing adult preventive care services, hoping to increase and maintain an individual’s health. Nevertheless, the usage rate was only around 40 percent. Furthermore, there are no other studies concerning subsequent medical utilization. Therefore, this research uses 「2001 National Health Interview Survey」and 「2001 & 2002 National Health Insurance Database」 which include 2,156 elderly aged beyond 65, to analyze the utilization of preventive care services in 2001 and medical utilization in 2002. The research uses logistic regression model to analyze the usage rate of preventive care services, and uses two-part model to analyze subsequent medical utilization. Logistic regression model is used in the analysis of whether or not an individual had received outpatient and inpatient care services. Negative binomial regression model is used to estimate the number of outpatient visits and length of stay in the hospital. Ordinary least squares regression model is used to analyze the medical expenditure. The study also uses instrumental variables in the regression in order to solve the endogeneity problem of medical utilization.The results show that the proportion utilizing preventive care services was only 31.03% which was quite low. There is a significantly positive likelihood of receiving preventive care services among those lived in the central and southern region. We also find that individuals aged 75 or more, have healthy status, have limitations in activities of daily living, do not exercise regularly, and smoked, there will tend to be a significantly lower likelihood of them using preventive care services. Moreover, individuals who use preventive care services tend to have higher probability of receiving outpatient service but lower length of stay during inpatient service. This indicates that serious illness can be detected and avoided in advance through preventive care services for the elderly.