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研究生:鄭千芝
研究生(外文):CHENG, CHIEN-CHIH
論文名稱:臺灣地區老年人口醫療利用之探討-全民健保前後比較
論文名稱(外文):Investigation of the medical utilization among the elderly in Taiwan-Pre- vs. post- NHI
指導教授:劉彩卿劉彩卿引用關係
指導教授(外文):Prof. LIU, TSAI-CHING
學位類別:碩士
校院名稱:國立臺北大學
系所名稱:財政學系
學門:商業及管理學門
學類:財政學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:127
中文關鍵詞:老年人口醫療利用全民健保
外文關鍵詞:the elderlymedical utilizationNational Health Insurance
相關次數:
  • 被引用被引用:14
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由於台灣已進入高齡化國家的行列,因此老年人口眾多,人口老化問題近趨嚴重。雖然老人是醫療上的高風險與高需求者,但我國在尚未實施全民健保前,因逆選擇之因,使得老人是最多未能獲得醫療保險的族群。而在全民健保實施後,由各項數據發現歷年來老年人口不僅醫療費用快速增高,並且醫療費用成長的速率也是居冠。因此本文旨在分析我國老年人口醫療利用情形,並比較全民健保實施前後的差異以檢視全民健保實施後,是否因減輕老年人就醫之經濟負擔,而使其醫療利用行為改變。
本文採用國民健康局所提供「台灣地區老人保健與生活問題長期追蹤調查系列研究」之民國82年與85年資料中的67歲以上老人進行研究。由於使用醫療服務的行為可被視為一種具有序列性之決策過程,因此就醫行為必須分成兩個決策階段。本文實證分析首先利用機率模型(Probit Model)衡量老人住院與西醫門診的就醫機率;一旦就醫過後,第二部分採用負二項分配模型(Negative Binomial Distribution Model)衡量住院與西醫門診就醫頻率。
實證結果顯示不論在全民健保前後,老人的健康情況如自評健康情況、醫生
告知的慢性病個數與日常生活活動困難個數仍是主要影響就醫機率與頻率的影響因素。而在全民健保前皆發現男性老人住院機率與天數皆顯著大於女性老人,而女性老人是在西醫門診次數上顯著領先男性老人。但是在全民健保開辦後,在就醫天數或次數上產生相反的情況。這是由於全民健保採行全民納保政策以及女性老人較易罹患長期性慢性疾病的原因所導致。此外實施全民健保前,教育程度為國高中的老人會減少住院天數,但全民健保實施後,反而會明顯多去利用住院
使用量。結果也顯示雖然已經實施全民健保,城市老人相對有較高的門診機率;而鄉鎮老人一旦就醫後會有較多門診的次數,這可能是城鄉之間的醫療可近性與醫療品質的差距並無完全改善的關係。結果也發現在全民健保實施後,的確讓經濟條件較差的老人相對顯著使用較多的西醫門診醫療使用量。即全民健保確實降低了就醫時的財務障礙,使低所得老人在西醫門診利用量上之醫療利用可近性提升。
The purpose of this study is to analyze the medical utilization among the elderly population in Taiwan. We compare and contrast the difference before and after implementing National Health Insurance (NHI).
Data used in this study was taken from “The 1993 and 1996 Survey of Health and Living Status of the Elderly in Taiwan”. The Probit Model was, first, adapted to estimate the probability of hospitalization and outpatient service utilization. The Negative Binomial Distribution Model was then applied to estimate the frequency of using such services.
The study reveals many differences pre and post NHI. First, in the pre-NHI period, the male elderly have higher probability and length of hospitalization than the female, but lower frequency of outpatient service attendant than their counterparts. However, the results become reversed after NHI. Second, regional difference occurred after NHI. The elderly living in the city have more outpatient service relative to those who live in the country side. However, those who live in the country side tend to have more outpatient service than their counterparts. This indicates that the different medical resources distribution and accessibility exist between urban and rural area. Finally, in the post-NHI period, the low-income elderly have higher outpatient services than the middle and high-income, suggesting that NHI tended to reduce the poor elderly more medical financial burden.
In conclusion, the health conditions, such as self-rated health status, chronic diseases and the difficulties in the activities of daily living are still the main factors effecting the probability and frequency of health care services use either pre- or post-NHI.
目錄
目錄.........................................................Ⅰ
圖次.........................................................Ⅲ
表次.........................................................Ⅲ
第一章 緒論..................................................1
第一節 研究背景............................................1
第二節 研究動機與目的......................................5
第三節 研究方法與資料來源.................................11
第四節 本文架構......................... .................13
第二章 文獻回顧.............................................15
第一節 相關文獻..........................................15
第二節 老人在全民健保中之醫療利用制度與福利措施..........29
第三章 理論與實證模型.......................................37
第一節 醫療利用行為模型.................................37
第二節 實證模型.......................... ..............42
第四章 資料來源與樣本特性分析...............................46
第一節 資料來源與說明...................................46
第二節 變數選取與預期...................................48
第三節 樣本特性與基本統計分析...........................63
第五章 實證結果分析.........................................72
第一節 住院機率分析.....................................72
第二節 住院天數分析.....................................81
第三節 西醫門診機率分析.................................90
第四節 西醫門診次數分析.................................99
第六章 結論與後續研究.....................................109
第一節 結論............................................109
第二節 研究限制與未來展望..............................117
參考文獻....................................................120
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