臺灣醫事人員於全民健保預防保健之利用分析

A study on the medical staffs’preventive care utilization under National Health Insurance

詹秀美(Hsiu-Mei Chan)

指導教授 ： 洪錦墩

中臺科技大學/管理學院/健康產業管理研究所/碩士(2011年)

摘要

中文摘要
背景與目的：臺灣近年各類預防保健服務，能順利推展且有良好成效，醫事人員有重要推動貢獻。預防保健服務對疾病控制及醫療費用控制有其重要的影響，但是醫事人員預防保健的利用是否確實，則有待驗證。本研究期望透過健保資料庫之次級資料分析，瞭解臺灣醫事人員本身對於全民健保預防保健服務之利用情形。
研究方法：利用國家衛生研究院全民健保學術研究資料庫之2005年的百萬人承保歸人檔，分析2006年至2008年間醫事人員各項預防保健服務之利用情形。依性別、年齡、社經地位、醫療資源可獲取性等因素為配對順序，以醫事人員為研究組，一般民眾為對照組，採1:3配對方式，再以SAS 9.1.3軟體進行描述性統計、卡方檢定等比較分析，並以邏輯式迴歸分析影響因素。
研究結果：醫事人員子宮頸癌篩檢之利用率為39.08%、成人健檢為22.01%、乳癌篩檢為15.12%，三項利用率均高於一般民眾，僅子宮頸癌篩檢未達顯著差異；不同服務機構層級的醫事人員在子宮頸癌篩檢及成人健檢之利用率有顯著差異，而乳癌篩檢則無顯著差異；不同類別的醫事人員在預防保健之利用率均有顯著差異；醫事人員的門診費用及次數與有無做子宮頸癌篩檢有相關，門診次數與有無做成人健檢有相關；有重大疾病者預防保健之利用較低，而有慢性病者預防保健之利用較高。

結論與建議：在成人健檢及乳癌篩檢項目之利用率醫事人員確實高於一般民眾，但在子宮頸癌篩檢項目則無顯著差異。醫事人員於預防保健服務利用確實達到自我實踐目標。但其利用率仍遠低於歐美水準，因此應有提昇之空間，特別在乳癌篩檢項目，期許預防保健服務推動能促成相關癌症早期發現與治癒之目標。

關鍵字：醫事人員、預防保健、健保資料庫。

關鍵字

健保資料庫 ； 預防保健 ； 醫事人員

並列摘要

Abstract
Background and objective:In recent years, various types of preventive health services in Taiwan, can be successfully extended to all regions and have good results, medical staffs are important to promote the contribution. Preventive health services for disease control and health care cost control has a significant impact, but medical staff themselves in the practice of preventive self-care is reliable and is subject to proof. Via the National Health Insurance database secondary data analysis, to understand Taiwan''s medical staffs for the utilization of preventive health care services under National Health Insurance.
Methods: Using the National Institutes of Health National Health Insurance Research Database(NHIRD) of the return in 2005, millions of people who file analysis from 2006 to 2008 between the medical staffs of the preventive health care services. Gender, age, socioeconomic status, health resources, factors such as accessibility to medical staffs as the study group, the general public as the control group, matched 1:3 mining approach to the SAS 9.1.3 software, descriptive statistics, χ2 test, etc. Comparative analysis, and Logistic regression analysis of factors.
Results: Medical staffs in the utilization of preventive health care in cervical cancer screening was 39.08%, 22.01% for the adult health examination, breast cancer screening there are 15.12% of usage, three were higher than the general population, but use less than significant differences in smear ; different service levels of medical staffs in cervical cancer screening and adult health examination of the utilization significant differences, but there was no significant difference in breast cancer screening; different categories of medical staffs of the utilization of preventive care are significantly different; the outpatient number and costs of medical staffs are associated with cervical cancer screening, the outpatient number of medical staffs are associated with adult health examination ; have major disease and preventive care utilization is lower, while have chronic disease and preventive care utilization is higher.
Conclusions and recommendations:Preventive care utilization in breast cancer screening and adult health examination of medical staffs are actually higher than the general public, but the project was no significant difference in cervical cancer screening. Medical staffs in the use of preventive care do to achieve self-practice target, but their utilization is still far below the European and American standards, it should enhance the space, especially in breast cancer screening, preventive care services will be better able to promote early detection and cure of cancer-related target.

Keywords: medical staffs,preventive care,NHIRD.

並列關鍵字

NHIRD ； preventive care ； medical staffs

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