民眾自費醫療服務利用之影響因素探討

The study on factors influencing people using out-of-poket medical services

黃鍾惠(Jhong-Huei Huang)

指導教授 ： 馬震中

義守大學/醫學院/醫務管理學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00231

摘要

研究目的：我國總額預算支付制度之實施，使醫院財務受到明顯限制，多數醫療院所相繼發展自費醫療服務市場，開闢另外財源管道來增加醫院收益。若政府未對民眾自費之成長加以監督，即使有效控制健保醫療支出，對民眾財務負擔將更加沉重。故本研究目的在探討影響民眾自費醫療服務利用之影響因素並提出相關建議。
研究材料與方法：本研究為橫斷式研究設計，資料來源為台灣社區醫院協會「101年民眾自付醫療費用問卷調查」之問卷結果，問卷發放期間為2013年4月至5月，研究對象為十六歲以上之全國民眾，問卷數共計3,000份，問卷回收數共2,243份。本研究將其問卷統計數據作為資料庫，從中擷取與本研究架構與目的相關之問卷內容作為本研究變項，並且剔除填寫不完整或內容明顯矛盾或錯誤之問卷後，最後總計之問卷樣本數為1,804份，有效問卷回收率為60.13%。次級資料分析以卡方撿定、t檢定、ANOVA、相關分析進行單變量分析，多變量分析則以複迴歸與二元Logistic迴歸進行分析自費服務醫療利用之影響因子。
研究結果：樣本性別以女性居多(占78.7%)，年齡多分布在31至40歲(占34%)，教育程度有70.3%是大學(含專科)。近八成的民眾有固定就醫之醫療院所，九成的民眾大多了解部分負擔、差額負擔、分級醫療與轉診制度之概念，七成民眾無慢性疾病，近六成民眾有定期檢查之習慣，自覺健康狀況之評分大多介於6至9分之間(滿分為10分)，近八成民眾身體不舒服會依病情之嚴重度而決定是否立刻就醫，半數民眾皆有過差額負擔與使用自費醫療項目之經驗，其滿意度多落在4分(滿分為5分)。家庭成員總年收、家庭扶養人口數、差額負擔之施行原則、自覺健康狀況、身體不舒服會立刻就醫，對差額負擔之滿意度有顯著性的影響(p<0.05)，此迴歸模式調整後的解釋力為7.1%(Adjusted R2=0.071)。教育程度、家庭扶養人口數、月繳健保保費(含眷屬)、慢性疾病、定期健康檢查之習慣、自覺健康狀況，對自費醫療項目之滿意度有顯著性的影響(p<0.05)，此迴歸模式調整後的解釋力為7.6%(Adjusted R2=0.076)。影響差額負擔之經驗之顯著預測因子為：性別、教育程度、個人年收入、月繳健保保費(含眷屬)、差額負擔之施行原則、慢性疾病、身體不舒服會立刻就醫(p<0.05)，整體預測模式解釋力R2=0.156。影響自費醫療項目之經驗之顯著預測因子為：性別、教育程度、月繳健保保費(含眷屬)、差額負擔之施行原則、定期健康檢查之習慣，整體預測模式解釋力R2=0.118。
研究結論：民眾在自費醫療之偏好與利用上，與其個人特質、就醫利用等因素有顯著相關性，因此醫療院所應提供完整之自費醫療資訊於院所網站，並可設立自費醫療諮詢管道，以利有興趣之民眾涉取與利用。另外，政府也應監督醫療院所自費就醫之資訊是否完整、公開化，以及自費醫療項目之合理的調整支付標準，並加強民眾分級醫療制度之觀念。

關鍵字

民眾自費 ； 自費醫療 ； 醫療服務利用

並列摘要

Objectives: Implementation of global budget payment system in Taiwan caused a lot of limitations related to financing and cost control of hospitals. Hence a lot of health care organizations have started to open out-of-pocket (private) health services to generate additional income. Even though the government has measures to control the national health insurance expenditures, if it doesn’t regulate out-of-pocket health services, financial burden for citizens will only become worse. Thus, this research aims to examine the factors influencing out-of-pocket medical services utilization and to formulate relevant recommendations for improvement.
Materials and Methods: This research employs a cross-sectional study design using data from the Taiwan Community Hospital Association’s 2012 survey results on citizens’ out-of-pocket medical expenditures. Survey population includes Taiwan citizens at least 16 years old during the duration of the survey which is April to May 2013. There were a total of 3000 questionnaires given out, and 2243 were collected back. Incomplete, invalid and/or conflicting responses were eliminated from the data pool, leading to a final amount of 1804 valid responses (effective response rate of 60.13%). Data analysis was done using Chi-square analysis, t-test, and ANOVA for univariate analysis; and multiple regression and second order logistic regression for multivariate analysis of factors influencing out-of-pocket medical services utilization.
Results: Majority of the sample were female (78.7%), 31-40 years old (34%), and with highest educational attainment being university (70.3%). Approximately 80% had a fixed health care facility they go to for their medical services. Around 90% understood the general concepts of co-insurance, partial payment, hierarchy of medical services and referral system. About 70% did not have any chronic disease. Nearly 60% had habits of regular health check. Majority of their self-rated health scores were between 6 and 9 (out of 10). Nearly 80% would decide whether to go seek medical advice based on the severity of their illness. Half of the respondents had experiences with partial payment and out-of-pocket health services; majority of the satisfaction scores with the said services at 4 (out of 5). Total family income, household number, partial payment regulations, self-rated health scores, and immediate health-seeking behavior with illness had significant correlation with satisfaction scores with partial payment (p<0.05, adjusted R2=0.071). Highest educational attainment, household number, monthly premium amount (including subsidiaries), chronic diseases, habits of regular health check, and self-rated health scores had significant correlation with satisfaction scores with out-of-pocket health services (p<0.05, adjusted R2=0.076). Significant predictive factors for satisfaction scores with partial payment include sex, highest educational attainment, personal annual income, monthly premium amount (including subsidiaries), partial payment regulations, chronic diseases, and immediate health-seeking behavior with illness (p<0.05, R2=0.156). Significant predictive factors for satisfaction scores with out-of-pocket health services include sex, highest educational attainment, monthly premium amount (including subsidiaries), partial payment regulations, and habits of regular health check (p<0.05, R2=0.118).
Conclusion: Personal attributes and health seeking behavior have significant correlation with out-of-pocket health service utilization. Hence, health care organizations should provide comprehensive online information on their websites and create an out-of-pocket health service consultation service for interested citizens. Moreover, the government should monitor the completeness and transparency of said information, regulate the cost of out-of-pocket health services, and strengthen the citizens’ knowledge on the concept of hierarchy of medical services.

並列關鍵字

out-of-pocket medical expense ； health care ； health service utilization

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