全民健康保險醫療資源分配 : 非醫療需要變數之影響

1. 全民健康保險醫療資源分配 :非醫療需要變數之影響 論 文 摘 要 論文名稱:全民健康保險醫療資源分配：非醫療需要變數之影響 研究所名稱:臺北醫學大學醫學研究所 醫務管理學組 研究生姓名:陳依琪 畢業時間: 八十九學年度第二學期 指導教授:湯澡薰 臺北醫學大學醫務管理學研究所 副教授 廖宏恩 臺北醫學大學醫務管理學研究所 助理教授 國民之健康乃是國家建設之基礎，因此國民是否能獲得合適的醫療服務乃是所有現代化國家所關心的議題。原因為何？簡單來說，生活上的所有活動都與健康情形息息相關，當疾病發生或預防疾病時會尋求醫療上的協助。因此醫療照護乃是人類基本且必需的福利。因此，為確保台灣民眾之健康需求，我國於84年3月1日開辦全民健康保險。 在全民健康保險實施之後，在健保之受益(benefits)方面，國人各社經階層之醫療資源使用及分配上仍可能存在顯著之差異。在基於醫療的本質與醫療資源使用之公平原則下，如何妥善分配國人之醫療資源及醫療費用負擔成為政策制訂者之主要目標之一。以及在疾病結構轉變為慢性疾病的今日，慢性疾病患者之所耗費之醫療資源較非慢性病患龐大許多。故慢性疾病之治療、照護及其龐大的醫療費用皆為現今醫藥衛生界所關注之重要課題。 本研究以「民國八十五年台灣地區全民健康保險滿意度調查」之對象為 基礎，加入受訪者居住所在地方之可近性之供給變數，如醫師數、醫院床數等。除此之外，為了解實際醫療使用之情況，故擷取中央健保局87年度之醫療費用申報檔，建構問卷受訪者在訪問後之實際醫療使用情形 ，包括中西醫門診之就診次數、就診費用及住院之住院天數、醫療費用等。並以SPSS及SAS軟體進行描述性統計及推論性統計。描述性統計擬採用百分比、平均數、標準差、卡方檢定。推論性統計擬採用複迴歸、負二項迴歸及羅吉斯迴歸等統計方式。 　　其中問卷調查之完訪人數為5,284人，最後納入年齡20歲以上己納保之受訪者，以及由於職業軍人之身份較為特殊，不將其列為本次研究範圍內，因此最後之樣本數為3,288人，其中罹患慢性疾病之人數為1151，其罹病率為21.7%。經研究分析後發現台灣健保醫療資源的分配的確有非醫療需要因素之干擾存在。其中影響全民健保醫療資源分配之非醫療需要變數，包括年齡、性別、婚姻狀況、教育程度、醫療信念等傾向因素以及能力因素之家戶所得、固定就醫地點及居住地區等因素。 關鍵字:全民健康保險、醫療資源分配、慢性病。

2. The Distribution of Taiwan''s National Health Insurance Resources: Do Non-Need Factors Matter? • Title of Thesis：The Distribution of Taiwan’s National Health InsuranceResources: Do Non-Need Factors Matter ?Author：I-Chi ChenThesis advised by：Chao-Hsiun Tang, Associate professorHung-En Liao, Assistant professorEvery modern nation is concerned about its citizen’s health and whether they have adequate access to health care . Why ? Simple question, our ability to live all depends on our health condition. Meanwhile ,we seek health care when we are sick and to prevent illness. So health care is a fundamental necessity for human’s well being, consequently for citizen’s health need ,we had to start National Health Insurance (NHI) in 1995.March.1th.Equity of NHI is view from two aspect: who pays and who benefits, and also equal need mean the health care resources should be distribution according to citizen’s health need. Base on those ethical foundations, how to allocated health care resources become a serious issue, and at the same time ,chronic disease also an important agenda, too. Because they cost lots of NHI resources , their treatment ,health care and expenditure that we have to take serious about .Our research population base on ‘1996 HNI satisfaction survey ’, and we collect their location supply side and 1998 health care utilization information, eg. Chinese and modern physician and hospital care times, length of days and expenditure. We test effective factors in delivery of health care by two-part model: First test are carried out separately for physician and hospital care; Second ,the test are carried out separately for the probability of seeking care and amount of care received. In first part related to determinants of an individual’s decision to seek care and the second to determination of amount of care received give some utilization( using times, length of days and fees). And we use chi-square, ANOVA and regression model to test factors significant level.The survey sample size are 5,284, after excluded noninsurance ,age under20 years old and professional military personnel ; our final sample include 3,288,and there are 1,151 chronic disease patients.After controlling for need factors (eg. Morbidity and health status), the non-need factors influence the Taiwan NHI resources allocation. In predisposing factor, age , gender, marriage status, education are important factors. And also on enabling factors has the same result, as household income, access to care has the highly relevance to health care resources utilization.Keyword: National Health Insurance, distribution of health care resources ,chronicdisease