人口高齡化現象已在21世紀蔓延,根據衛生福利部「民國101年國民醫療保健支出資料」指出,50歲以上及60歲以上國民所使用的醫療費用,分別約佔總醫療費用的62.15%及43.6%(衛生福利部, 2012),顯示中高齡人口為醫療資源的主要使用者,而健康與醫療照顧服務的提供是中高齡生活中最受關注的議題。然而全球100多個國家代表與衛生專家一致認為,不論是在哪個國家,個人的健康狀況相當程度取決於個人的社經地位(WHO, 2011)。因此本研究將以中高齡人口為對象,探討其個人社經地位與醫療利用之影響。同時考量來自地區層次的影響,將地理特性一併納入,因此,本研究將以個人面及地區面來探討中高齡人口醫療利用之影響。 本研究採用衛生福利部國民健康署2007年「台灣地區中老年身心社會生活狀況長期追蹤調查」,取得全國代表性樣本其個人社經地位及醫療利用情形。此外,地區剝奪的數據來自於行政院主計處「人口及住宅普查」及內政部戶政司「全國人口統計」。所有數據將以SAS 9.3軟體進行描述性統計分析、卡方檢定(chi-square test)及邏輯斯逐步複迴歸(stepwise logistic regression)等分析。 研究結果顯示,在控制年齡、性別、婚姻狀況、社會支持、其他保險、就醫方便性、就醫時間、自評健康、ADL、IADL、慢性疾病、重大傷病、抽菸、飲酒、嚼檳榔及不運動等變項後,地區剝奪程度、夫妻總收入、教育程度及工作職業狀況對醫療利用有顯著影響,僅有房屋所有權未達統計上顯著意義。
Background: The 20th century’s rapid aging population brought important economic, politic and social change to Taiwan. According to the ministry of health and welfare data shows that middle-aged and elders are main user of healthcare utilization. Therefore, keep the health and supply healthcare service is issues of concern. Objective: This study examined the area deprivation and socioeconomic status for predicting healthcare utilization in middle aged and elders in Taiwan. Methods: Data from the 2007 wave survey of Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were analyzed. This study collected individual socioeconomic status and healthcare utilizations. In addition, data of area deprivation came from Population and Housing Census. All data were analyzed through the descriptive analysis, chi-square test and stepwise logistic regression by SAS 9.3 software. Results: After adjustment for three predisposing factors (age, gender, marital status), four enabling factors (social support, medical insurance, medical accessibility and medical time) and five need factors (self-ranked health status, ADL, IADL, chronic disease and catastrophic disease). Demonstrated that significant determinants of medical utilization by the area deprivation, income of couples, education, occupation.