全民健保實施前後影響子宮頸抹片篩檢之因素及成果

Utilization Factors and Effects of National Health Insurance on Cervical Pap Smear Tests in Taiwan

陳慈怡(Tzu-I Chen) ； 李嬿如(Yen-Lu Lee) ； 游山林(San-Lin You) ； 陳建仁(Chien-Jen Chen) ； 謝長堯(Chang-Yao Hsieh) ； 陳素秋(Su-Chiu Chen)

《台灣公共衛生雜誌》 24卷5期 (2005/10) Pp. 440-451

https://doi.org/10.6288/TJPH2005-24-05-08

摘要

目標：子宮頸癌是台灣地區女性好發的癌症之一，也是最容易早期發現且治癒效果佳的疾病，因此是最適合進行篩檢的疾病之一。本研究目的即以世代追蹤研究設計探討健保實施前後，影響此世代接受篩檢的原因及成果。方法：本研究自1991年起，對於台灣地區七個鄉鎮，30-64歲10，780位已婚婦女進行子宮頸癌篩檢計畫，結合健保子宮頸癌篩檢資料檔、全國癌症登記檔及死亡檔，追蹤十年之篩檢相關資料，以Multinomial Logistic Regression、Cox's Proportional Hazard Model分析探討之。結果：研究發現年齡較高、教育程度較低、加入計畫案到健保前無定期篩檢之婦女，較不定期接受篩檢。而進入計畫案前曾有篩檢過或曾因婦科疾病就醫、加入計畫案到健保前有定期篩檢、健保前無保險及曾子宮頸抹片或攝影為陽性者較會定期接受篩檢，定期接受篩檢對於篩檢成果較佳。結論：雖然我們目前沒有足夠的證據說每年、每兩年及每三年的篩檢成果何者較佳，但若能鼓勵高危險婦女定期篩檢，則可提早發現子宮頸癌前病變及治療，進而節省醫療資源。

關鍵字

子宮頸抹片 ； 全民健保 ； 篩檢成果 ； 定期篩檢

並列摘要

Objectives: In Taiwan, although cervical cancer is one of the most common cancerous conditions in females, it is the easiest to detect early by the cervical Papnicolaou (Pap) smear test and therefore treat effectively. The purpose of this study is to evaluate the utilization factors and effects of universal health insurance on cervical Pap smear tests in Taiwan. Method: This study invited 10,780 married women aged 30-64 years old living in seven communities of Taiwan since 1991. Database sources were from the cervical cancer research project and linked to the national files of the cervical neoplasia screening registry, cancer registry, and death certification from the department of health. Multinomial Logistic Regression and Cox's Proportional Hazard Model analysis were performed. Result: The low utilization factors of regular Pap smear tests were a low education level, and irregular Pap smear tests prior to the beginning of national health insurance. On the other hand, high utilization factors included women who had ever had the cervical Pap smear test or gynecological diseases prior to study entry, no insurance, Pap smear test/cervicgraphy positive finding or regular Pap smear tests prior to July 1995. The results of regular Pap smear tests were better than irregular ones. Conclusion: Although we thoroughly analyzed the results of regular one-year, two-year, and three-year Pap smear test outcomes, it is unclear as to which time period was better. However the women at a high risk of developing cervical cancer are encouraged to have regular Pap smear tests for the early detection and treatment of cervical neoplasia, therefore effecively saving medical costs.

並列關鍵字

cervical Pap smear test ； national health insurance ； screening outcome ； regular screening

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