全民健康保險第五類被保險人醫療利用之探討

Medical Utilization of Low-Income Families in Taiwan's National Health Insurance

吳佳蓁(Chia-Chen Wu)

指導教授 ： 鄭文輝

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

本研究旨在探討全民健康保險第五類被保險人醫療利用情形，分別從就診率、就醫次數、住院天數及醫療費用等方面來探討，並特別針對醫療耗費高的重大傷病及慢性病，如癌症、洗腎、精神病、糖尿病及高血壓等五大疾病分析其醫療利用，與非第五類被保險人平均使用情形逐一比較；研究資料來源為2004年全民健康保險研究資料庫抽樣歸人檔；共抽出1,843名第五類被保險人，整理相關資料予以分析。
　　研究結果發現第五類被保險人的醫療利用率為81.39%，比非第五類被保險人的平均低13.6%，女性的利用率高於男性，少年人口(5~14歲)的利用率最高，老老人的利用率最低，且65歲以上的人口醫療利用率隨年齡增加而減少；以居住地區分醫療利用率最高的是南區分局，最低則是東區分區。
　　門診利用率為80.79%，比全國平均少14.20%；住院利用率為14.11%，較非第五類被保險人高8.54%；精神科住院的比率較非第五類被保險人高39.24%。選擇住院的醫院層級差異較大的是第五類被保險人近半數選擇至地區醫院接受住院醫療，比非第五類被保險人平均高22.39%，選擇醫學中心住院比率較非第五類被保險人低15.27%。
　　罹患重大傷病的比率是全國樣本的3.08倍，罹患慢性病是非第五類被保險人樣本的1.1倍，因重大傷病及慢性疾病而就醫，是非第五類被保險人的4.66倍；顯示第五類被保險人是一群有醫療需求但缺乏利用的族群。

關鍵字

第五類被保險人 ； 低收入戶 ； 醫療利用

並列摘要

The study focuses on the medical utilization of low-income families in Taiwan’s National Health Insurance, in terms of the attendance rate, the number of medical treatment, hospitalization days and medical expenses. Their medical uses are then compared with those of an average insured person one by one, particularly, on five major injuries and chronic diseases such as cancer, renal dialysis, mental illness, diabetes and high blood pressure. The data come from the sample file of 2004 National Health Insurance Research database, in which 1,843 low-income people are selected randomly, and their relevant information are edited and analyzed.
　　Major results show that overall utilization rate of low-income families is 81.39% that is less than the national average by 13.6%. Among various low-income groups, women use more than men; young population (5 to 14 years old) have the highest utilization rate, while the old population over 65 have the lowest utilization rate and keeping decreased with the age increasing. For inhabitation in different regions, the highest utilization takes place in the Southern District branch, and the lowest in the Eastern.Division.
　　Though low-income families have less out-patient utilization, 80.79%, than the national average by14.2%, their hospital utilization rate of 14.11% is much higher than national average by 8.54%. Conspicuously, their ratio of psychiatric hospitalization are 39.24% higher than the national level.
Patient choices among different hospital levels are also quite different. Nearly half of the low-income families select regional hospitals for inpatient health care, which is higher than the national average by 22.39%, meanwhile, only about 15% of them choose medical centers that is lower than the national average by 15.27%.
The prevalence rate of suffering from major injuries for low-income people is 3.08 times of the national sample, while the rate of chronic diseases is 1.1 times of the national sample. The results show that low- income families have high medical need but sill lack of access to realize necessary medical treatments. That implies several suggestions for assisting low-income people to seek`due medical treatments.

並列關鍵字

National Health Insurance ； medical utilizatio ； low-income families

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