從全民健保研究資料庫評估高齡人口的醫療利用

Using National Health Insurance Database to Evaluate the Health Care Utilization of Taiwan's Elderly

余清祥(Jack C. Yue) ； 王信忠(Hsin-Chung Wang) ； 許筱翎(Hsiao-Ling Hsu)

《人口學刊》 58期 (2019/06) Pp. 89-120

https://doi.org/10.6191/JPS.201906_58.0003

摘要

因應我國快速人口老化，近年有不少政策規劃與高齡化有關，而與老年生活需求有關者又可分為三個面向：經濟、醫療、照護。由於現在對人類壽命變化趨勢瞭解仍舊不足，致使許多政策需要根據現況調整，確保制度的財務健全及永續經營，例如我國勞工保險退休金條例、軍公教年金改革等。國內外對於退休生活的研究以經濟需求居多，但單純依賴壽命不足以描述生活品質，需要加上健康方面等需求，因此本文目標為探索高齡人口的醫療利用，分析就醫次數、疾病類型、醫療院所等特性，評估我國老年人的健康現況及需求。本文依據全民健康保險研究資料庫2005年百萬高齡抽樣檔，輔以2005年百萬人抽樣檔，其中高齡檔的抽樣比例約為45.7%，亦即每兩位65歲以上人口就有1人被抽出，減少高齡人口樣本數不足的影響，提高估計值的準確度。套用本文提出的死亡判斷準則，健康保險高齡抽樣檔提供相當可信的高齡死亡率，與內政部公布值非常接近。此外，除了門診次數及金額較高，發現老年人口醫療利用的年成長率也較高，而且就醫時有明顯的慣性行為，愈集中在同一地點就醫的死亡率愈低。

關鍵字

人口老化 ； 醫療利用 ； 長壽風險 ； 全民健康保險 ； 巨量資料

並列摘要

Population ageing is speeding up in Taiwan due to the lower fertility rates and declining mortality rates. Thus, the life arrangements after retirement have been receiving a lot of attention in recent years, and more public resources have been allocated to elderly-related policies. The elderly's needs can be classified into three categories: finances, medical utilization, and living care, and many countries have devoted efforts in seeking the solutions to fulfill these needs. However, it is a difficult task, since we don't have enough information about the elderly. Take the study of mortality improvement and life expectancy as an example. The trend toward longer lives surprises many people, and the annual increment in life expectancy is still over 0.2 years in many countries. Underestimation of life expectancy causes financial insolvency in public insurance systems and the private sector. Our study goal is to explore the medical needs of Taiwan's elderly via estimating their medical utilization, such as inpatient and outpatient visits. The study material is a sample data set of one million elderly people from Taiwan's National Health Insurance Database. The sample coverage is about 45.7%, i.e., almost one in two of Taiwan's elderly are drawn, and this big data sample can greatly reduce the sampling bias and increase the accuracy of estimation. For example, we used this sample data to estimate the elderly mortality rates and found that they are very close to the official statistics. Also, the medical utilization of Taiwan's elderly has a high degree of inertia.

並列關鍵字

population ageing ； medical utilization ； longevity risk ； National Health Insurance ； big data

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