醫療院所特質與醫師特質對未成年氣喘患者醫療資源耗用的影響

Impacts of Characteristics of Medical Care Organizations and Physicians on Medical Resources Utilization of Children with Asthma

黃家達(Jia-Da Huang)

指導教授 ： 黃國哲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00104

摘要

因為氣喘的治療是長期性的，尤其兒童本來就屬於服藥順從性相對不佳的族群，會耗用到相當程度的醫療資源。在各健保分局地區分配資源差異及醫療院所層級間醫療資源分配不對等以及不同的醫師特質下，患有氣喘的兒童在治療上是否會因以獲取最大收益的考量下而有所不同。
本研究係以2010年全民健康保險研究資料庫為資料來源，選取未成年氣喘病人為研究對象，並採用線性方程式將資料分為門診、急診及住院三部分來探討台灣兒童氣喘病人的醫療資源耗用與醫師特質及醫療院所特質間的相關性。本研究將病人特質（如年齡、性別及疾病嚴重度）列為控制變項，進一步分析醫療院所特質（如健保分局別、權屬別、醫療院所層級及就醫科別）及醫師特質（如性別、年齡、專科別及專科年資）與醫療資源耗用（醫療費用及每日藥費）間是否有顯著性差異及相關性。
門診部分，健保分局別、就醫科別對醫療資源耗用沒有無顯著相關，公立醫療機構不論在門診醫療費用或是門診每日藥費均較其他權屬別為高。而醫師特質對醫療資源耗用均無顯著相關。急診部分在醫療院所特質中除部份分局別對急診每日藥費有顯著相關外，餘醫療院所特質對急診醫療費用均無相關。專科年資及病人年齡對急診每日藥費有顯著相關。住院部份，公立醫院、醫學中心對住院醫療費用有顯著相關，且較其他權屬別、醫療院所層級為高。小兒科對住院醫療費用亦有顯著相關，相較其他科別小兒科有較低之住院醫療費用。
整體來說，公立醫療機構普遍較其他醫療機構有較多的醫療資源耗用，而醫學中心所耗用的醫療資源也較其他醫療院所層級為多。而不論是分局別或是就醫科別，大多對醫療資源耗用沒有顯著相關。醫師特質中普遍對醫療資源耗用無顯著相關。
最後，本研究依據分析結果，提出下列幾項建議給予衛生主管機關參考：1、鼓勵未成年兒童選擇適當科別就診。2、衛教民眾，減少對醫療院所層級的迷思。3、基層醫療院所擔任家庭醫師功能保障民眾健康。

關鍵字

醫療院所特質 ； 醫師特質 ； 醫療資源 ； 氣喘 ； 未成年

並列摘要

The time of treatment about asthma is long. Especially, children are the population who take medicine as order poorly. They will utilize medical resources much. Will the medical resources utilization of children with asthma be different between differ from medical care organizations and physicians?
We divided the Nation Health Insurance Research Database into outpatient, emergency and inpatient three parts to explore the correlation between medical resource utilization of children with asthma and the differ from medical care organizations and physicians. The characteristics of patient are age, sex and Charlson Comorbidity Index. The characteristics of medical care organizations were the branch about Bureau of National Health Insurance, ownership, level of medical institution and clinical specialty. The characteristics of physicians are age, sex, physician specialist and the seniority of physician specialist.
In outpatient, the branch about Bureau of National Health Insurance and clinical specialty didn’t correlate with medical resources utilization. The medical resources utilization in public medical institutions were higher at outpatient total medical expenses and outpatient medicine expense per day. The characteristics of physician didn’t correlate with medical resources utilization. In emergency, some branch about Bureau of National Health Insurance correlated with medical resources utilization, but others didn’t correlate with medical resources utilization. The physician specialist and patient age correlated with emergency medicine expense per day. In inpatient, the public medical institutions and medical centers correlated with inpatient medical resources utilization and the medical resources utilization in public medical institutions and medical centers were higher than ohters. The pediatrics correlated with inpatient medical resources utilization also. The inpatient medical resources utilization in pediatrics were higher than others.
It is recommended that first, children shold be treated for pediatrics. Second, health education avoid people tend toward higher level of medical institutions. Finally, the clinic takes the responsibility of primary doctor.

並列關鍵字

Characteristics of medical care organizations ； Characteristics of physicians ； Medical resources utilization ； Asthma ； Children

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