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研究生:郭巧儀
研究生(外文):Chiao-Yi Kuo
論文名稱:多醫就診者之醫療利用及其影響因素
論文名稱(外文):Health Care Utilization and Determinants among Doctor-Shoppers in Taiwan
指導教授:李丞華李丞華引用關係
指導教授(外文):Cheng-Hua Lee
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
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
中文關鍵詞:多醫就診者醫療利用
外文關鍵詞:Doctor-ShoppersHealth Care Utilization
相關次數:
  • 被引用被引用:30
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摘要
ㄧ、背景
民眾藉由醫療服務之利用以達健康之完善。台灣現行之健保制度,並未限制消費者就醫選擇、就醫次數,即消費者擁有充分之就醫選擇的自由(freedom of choice)。然此制度下是否會造成消費者多醫就診行為?國內外研究顯示多醫就診(Doctor Shopping)其會造成(1)醫療費用上升(Demers 1995 , White-Means 1989);(2)醫療資源浪費(Klienschmidt 1995);(3)醫療持續性照護品質下降(張苙雲 1998 , Lo 2003)。然因目前台灣相關研究甚少,所以本研究首先定義多醫就診者(Doctor Shopper),並進一步探討其影響因素。
二、目的
本研究首先定義何謂多醫就診,進而根據(ㄧ)人口特質,含性別、年齡、是否具原住民身份。(二)社經地位,含投保金額、投保類別。(三)健康狀況,含殘障、重大傷病、慢性病、疾病數、當年住院與否。(四)居住地區,含都市化程度、每千人口西醫師數、醫療區。等四大類描述多醫就診於台灣之分布狀況,繼而探討多醫就診之相關影響因素,並著重於社經地位及健康狀態之分析。
三、方法
本研究運用國家衛生研究院「全民健保學術研究資料庫」之次級資料進行分析,包含 2000 年之承保資料檔、門診處方及治療明細檔、住院醫療費用清單明細檔、重大傷病證明明細檔等,另再串聯醫療資源資料、戶籍資料檔後,去除新生兒、年中死亡者、投保中斷者,尚餘151,480人為本研究之樣本。觀察樣本於2000年之醫療利用狀況。並依Demers(1995年) 運用加拿大魁北克省之資料庫定義多醫就診定義,採用一年內,看診醫師數分佈大於95百分位者,即看診醫師數大於20位醫師者。而本國採用此定義為看診醫師數大於12位以上者為多醫就診者。本研究並以小於11位者為對照組進行比較分析。分析內容含(1)描述型分析;(2)雙變項分析;(3)多變項分析等。
四、結果
本研究之重要結果如下
(一)年齡較小者與年齡較老者,其為多醫就診之比率較高。
(二)投保身份為榮民者,其為多醫就診之比率較高。
(三)健康狀況較差者,其為多醫就診之比率較高。
(四)居住地區之醫療資源豐富者,其為多醫就診之比率較高。
五、結論
研究結果顯示現行台灣多醫就診者多為兒童、老年人、榮民、健康狀況差者,以及居住於醫療資源豐富地區者。由此可知多醫就診者多為弱勢族群者。建議未來研究者可進一步探討多醫就診者與非多醫就診者對於醫療照護預後品質之影響。
Abstract
Background
With the use of medical care, the health will reach perfection. Consumers has not been limited in selecting medical advice and the number of times of medical advice from the present Heath Insurance System in Taiwan; that is, consumer has completely freedom of choice in medical advise. Weather this system will cause more consumer seeking medical advice? The literature shows that Doctor Shopping have caused the increases of hospitalization cost (Demers 1995, White-Mean 1989), the wastes of medical recourses ((Klienschmidt 1995), and decline of continuous medical care (Chang, 1998, Lo 2003). The relevant research is rare in Taiwan, therefore, this research defines the Doctor Shopper first, and than explore its influence factors.
Objective
This research defines the Doctor Shopping first, and then the distribution of medical advice in Taiwan is divided into four groups, by (1) population characters: sex, age and aboriginals; (2) social status: including insurance amounts and types; (3) health: including disability, serious sick, chronic diseases, whether stay in hospital or not in that year; (4) residential area: including urbanization degree, western doctors per thousand people, and medial district. The next step is to explore the influence factors of Doctor Shopping and it is focused on the analysis of social status and healthy situation.
Methodologies
The second data of “National Health Insurance Research Database” provided by the National Health Research Institutes is applied in this research. The samples include insurant data, clinic prescription and treatment details, medical statement expenses, serious disease prove details in 2000 and are combined with medical recourse data and householder register data, then are omitted new born baby, death in midyear, and people who cut off his insurance. Therefore, the sample size is 151,480 in total. This research observes the situation of medical use in 2000, and applies the definition of Doctor Shopping in database of Quebec of Canada. Within one year, the distribution of medical advices more than 95 percent, which seeking medical advice more than 20 doctors is defined as doctor shopping in Canada; however, in Taiwan, seeking medical advises more than 20 doctors is defined as doctor shopping. A contrast group, less than 11 doctors, is also investigated for comparative analysis. The analysis is involved (1) statement analysis; (2) Bivariate analysis, (3) Multiple variable analysis.
Findings
The focal findings of this research present as follow:
1. The ratios of Doctor Shopping of children and elders are higher.
2. The ratio of Doctor Shopping of veterans is higher.
3. The residences with worse heath have higher ratio of Doctor Shopping.
4. The residences live in where medical recourses are rich have higher
ratio of Doctor Shopping.
Conclusion
According to this research, most Doctor Shoppers are children, elders, veteran, and residences whose health is worse and who live in where the medical recourses are rich. It implies that Doctor Shopper from weaker groups. It is suggested to deeply explore the impacts of Doctor Shoppers and Non Doctor Shoppers on progress medical qualities.
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