全民健保職能治療利用率及相關影響因素

Utilization of Occupational Therapy Services and its Determinants

鄒明倫(Ming-Lun Zou)

指導教授 ： 楊志良

亞洲大學/健康學院/健康管理研究所/碩士(2009年)

摘要

研究緣起：全民健康保險的實施是我國近十五年來相當重要的衛生及社會建設，提供了全民綜合性的醫療保障，降低就醫障礙。對保險人而言，若能適切的掌握各項醫療服務利用及醫療資源的分配，例如利用頻率、就醫科別、疾病類型以及歷年的變化情形，則可加以分析以進行衛生政策的規劃調整，促使在有限的醫療資源下服務能被合理的運用。在醫療利用上，職能治療是不可或缺的一環，卻鮮少專家學者關注職能治療的利用情形。

研究目的：本研究主要是瞭解健保對象在職能治療，從1997到2006年的性別、年齡別及地區別等利用率及其變化趨勢，以及影響民眾利用職能治療的相關因素。

材料與方法：本研究以2007年所發行之全民健保資料庫承保抽樣歸人檔第一組到第五組為研究對象，合計共20萬人。申請資料年份為1996-2006年，為一重複橫斷式之研究（repeated cross-sectional study）。首先探討保險對象有無使用職能治療的情形，其次則選取歷年曾利用職能治療的民眾進行分析，除計算歷年利用率外，並以二部模式（two-part model）作為推論性分析的主要方法。最後本研究以Microsoft Office Excel 2007以及SPSS14.0 for Windows統計套裝軟體做為資料處理以及分析的工具。

研究結果：我國保險對象職能治療利用率由1997年0.31％上升至2006年0.92％，十年平均年成長率為12.57％，平均利用人次十年平均年成長率1.19％。性別方面，男性職能治療利用率由0.37％上升至0.91％，十年年平均成長率為12.64％，女性職能治療利用率由0.26％上升至1.08％，十年年平均成長率為12.49％。年齡方面以老年、青少年十年年平均成長率較高（12.51％-21.90％）。各分局別十年年平均成皆在10.79％-15.96％之間，以高屏分局有較多的成長幅度。本研究結果顯示穩定的影響因素為（連續數年皆呈現顯著水準，且具有相同的正負趨勢）：性別、年齡、職業類別、有無重大傷病、有無職業病。其中，年齡會因為需要不同，分別呈現不同的利用可能性與次數。其他較不穩定的影響因素（部分年度呈現顯著水準），如：有無慢性病、月投保薪資、是否為低收入戶、健保分局別、西醫師人口比、職能治療師人口比。

關鍵字

全民健保 ； 職能治療利用率 ； 職能治療

並列摘要

Background: The National Health Insurance (NHI) is the most important social program in Taiwan in the last century. It provides universal as well as comprehensive healthcare. As a result, the access to care is much improved. To insurer, the appropriate use of various medical services data, such as the incidence of diseases, the frequencies of services used etc. and their variation over the years can be analyzed for health policy planning. However, there were very few studies concerning the utilization of occupational therapy.

Objective: The purpose of the study was to estimate the utilization of occupational therapy among insured according to gender, age, health insurance branch, etc. and their trend from 1997 to 2006.

Material and Methods: The study was a repeated cross-sectional study. The source of data of the individual characters and the services of occupational therapy were came from the claimed data of first to fifth set of sampled registry of beneficiaries of National Health Insurance from 1996 to 2006. In addition to calculate the utilization of occupational therapy from 1997 to 2006, we used the two-part model to analysis the effect of those socio-economic variables on the utilization of occupational therapy. We used SPSS14.0 as well as Microsoft Excel 2007 for the data processing and the statistic analysis.

Results and Conclusion: The utilization of occupational therapy in from 0.31% in 1997 raised to to 0.92% in 2006. The average annual growth rate of those 10 years is 11.49%. With regard the gender, the male utilization rate increased 0.37% to 0.91% with an average annual growth rate of 11.31%, female utilization rate raised from 0.26% to 1.08% with an average annual growth rate of 11.18%. With regard to age, the elderly and those around ten years old, the average annual growth rate is relatively high (16.72%-20.17%). With regard to the brunch bureaus, all of them the average annual growth rate were 9.66% to 14.26%, with the Kao-Ping Branch had the highest growth rate.The results of this study show those variables with stable impact on utilization (a row indicates significant effects in several years and with the same positive and negative trends): gender, age, major injuries and occupational disease. Other factors such as chronic disease, insured salary, low-income households, health insurance branch, physician population ratio, occupational therapists population ratio were significant on utilization only among part of those 10 years.

並列關鍵字

Health Care Insurance ； Utilization of Occupational Therapy ； Occupational therapy

參考文獻

吳希文（2004）。長期收容機構慢性精神分裂症病患的職能參與。未出版之碩士論文，國立臺灣大學職能治療研究所，臺北市。

吳肖琪、吳義勇、熊嘉玲、藍忠孚（1998）。全民健保實施後住院病患復健治療利用分析。中華衛誌，17(1)，19-27。

蘇喜、黃月桂、李丞華、郝宏恕、湯靜怡(1997)。健保資料庫在醫療資源耗用及醫療品質偵測上之功用。中華公共衛生雜誌，16(6)，527-537。

江東亮（1995）。台灣醫師人力政策：1945-1994。中華衛誌，14(5)，383-391。

石曜堂、葉金川、楊漢湶、羅紀琼、張明正、吳正儀（1994）。台灣地區國民自付醫療費用調查：1992年國民醫療保健支出調查之初步發現。中華衛誌，13(6)，73-484。